LIBRARY OF CONGRESS, 

Tfe^v 



UNITED STATES OF AMERICA. 




W^R^Q^MsA 



PRACTICAL 

MEDICAL AND SURGICAL 

FAMILY GUIDE 

IN EMERGENCIES. 

A MANUAL 

EXPLAINING THE TREATMENT OF DISEASES, ACCIDENTAL INJURIES AND 

CASES OF POISONING WHICH DEMAND PROMPT ACTION 

IN THE ABSENCE OF THE PHYSICIAN. 

HINTS AND HELPS ON HEALTH. 

HOME NURSING AND REMEDIES. CARE OF CHILDREN. HOW TO COOK FOR THE SICK, ETC. 



ALSO 

A COMPLETE PRONOUNCING VOCABULARY OF MEDICAL TERMS. 

DESIGNED FOR 

FAMILIES, STUDENTS, TEACHERS, AND PRACTITIONERS OF MEDICINE. 




^i</?V-Z. 



" He that doth not know those things which are of use for him to know is but an 
ignorant man, whatever he may know besides."— Tillotson. 



: 



M A 



Entered according to Act of Congress in the year 1894, by 

W. P. KISTLER, M.D. 

In the Office of the librarian of Congress, at Washington, D. C. 



BERKEMEYER, BECHTEL & CO., 

BOOK AND JOB PRINTING, RULING, BINDING, 

ALLENTOWN, PA. 



This Hanual 
Is Gratefully and Affectionately 

Dedicated to 

Kiev, B. 1R. Iborne, 2>.2>., 

In Admiration of His Scholarly Attainments, 

His Sterling Qualities as a Man, 

And His Untiring Devotion 

TO THE 

Cause of Education 

by HIS 

Friend and Former Fufil. 



PREFACE. 



THIS edition has been expressly written to benefit and bless 
suffering humanity everywhere. Observations during a long 
and busy professional career, have impressed the writer with 
the belief that a book giving plain directions as to what should 
be done in cases of diseases, of everyday accidents and poisoning, 
as well as the means of studying some of the laws that govern 
and regulate our being, would be of decided benefit, not only to 
families, teachers, etc., but to the laity generally. It is with such 
an end in view, that this manual is placed in their hands, presenting 
succinctly, but at the same time in a sufficiently comprehensive 
manner the treatment of the many emergencies which are 
continually arising in our everyday life. 

The language is simple, and technical terms have been (as 
much as possible) carefully omitted, thus the book makes up a 
complete guide to health, which can be read and understood by 
all classes. The sections on home nursing and remedies, the care 
of children and the observations upon diet, ventilation, disinfection, 
etc., will be found particularly interesting and instructive. The 
receipes for the sick are replete with facts and lessons especially 
commendable to mothers and to those under whose care the sick 
usually fall. Even in health it is well to know something of the 
constituents of our food and what purpose each serves in the economy 
of nature ; and, when sickness, and its effects upon the system, are 
taken into account, it becomes worthy of our seriotis consideration. 
A constantly recurring problem is therefore — what food are we to 
give the sick, and when and how should we administer it ? 



Vlll PREFACE. 

Here the solution can be found, and the necessary instructions 
to make each preparation the best of its kind, by its being well 
cooked, palatably seasoned, and attractively served. 

" We are indeed fearfully and wonderfully made," and when 
we think of the powers, faculties and gifts bestowed upon us we 
cannot but exclaim with Shakespeare : "What a wonderful piece 
of work is man ; how noble in reason, how infinite in faculty; how 
like an angel, how like a god." Health is a physical condition 
upon which pleasure, success and happiness depend. Upon the 
health of its people is based the prosperity of a nation, for by it 
every power is increased, every joy enhanced. Sickness thwarts 
the best intentions and the loftiest aims, and life is incomplete and 
a failure without the enjoyment of a vigorous constitution. We 
are continually borne upon the tide of progress and happiness if 
we possess healthy organs and hopeful hearts. It is indeed 
wonderful how much we can add to our own personal comfort and 
length of days by acquiring a practical knowledge of our physical 
construction and the means of retaining that greatest of earthly 
blessings — health. It behooves every one to make the best use of 
their opportunities in learning all they can about themselves in 
health as well as in sickness. We best meet the purpose of life by 
doing all we can to preserve the race, by comforting and sustaining, 
as well as by alleviating the suffering of mankind. 

If this little book in any way succeeds in doing this, it will 
have accomplished the writer's purpose, and like our dear Master 
" be ever going about and doing good," so that all who secure it 
will find it ever helpful in giving good counsel in sickness and 
will find it a safe, trustworthy guide in health. 

W. P. K. 

313 North Seventh Street, 
January, 1895. 



CONTENTS, 



Frontispiece, - 

Preface, - vii-viii. 

Contents, - - - ix-xiv. 

CHAPTER I. 
Accidents and Emergencies in General. 

Introductory Remarks. Shock and its Treatment. How to Carry an Injured Person. 
Fractures— A Full Description of the Different Kinds of Fractures. What to Do until 
Medical Assistance Can be Obtained. Dislocations— How to Detect Them. Sprains — 
Their Importance and Treatment. 

1-6. 

CHAPTER II. 
Accidents and Emergencies. — Continued. 

Collapse or Shock in Grave Accidents and What to Do — Full Instructions. Syncope or 
Fainting. Burns and Scalds, from Fire or Hot Water and Steam. Burns by lime, 
Caustic-Potash and Other Alkalies. Burns by Acids— Sulphuric (Oil of Vitriol)— Nitric 
(Aqua Fortis) — Etc. Baking Soda — White of Eggs— Lime-water and linseed Oil 
(Carron Oil). Splendid Home Dressings. 

7-H. 

CHAPTER III. 

Accidents and Emergencies.— Continued. 

All Kinds of Wounds and Contusions or Bruises— How to Treat Them. Bleeding from the 
Mouth or Rectum in Case of an Injury. Mashed Fingers or Toes. How to Stop 
Bleeding from Wounds. Antiseptic Agents in Wounds. What to Do Where the Lungs 
or Bowels Protrude. The Extraction of Needles and Splinters. What to Do in Bites 
of Venomous Serpents. How to Treat the Bites of Insects. Valuable Suggestions in 
the Bites of Dogs or Other Animals. Gunshot Wounds, etc. 

I5-20. 



X CONTENTS. 

CHAPTER IV. 

Accidents and Emergencies. — Continued. 

Asphj-xia — Its Meaning. Asphyxia from Drowning — Resuscitation. How to Determine 
Whether Life is Extinct. How to Save Lives. Methods of Producing Artificial 
Respiration. Asphyxia from Strangulation by Hanging. Asphyxia from Suffocation 
with Noxious Gases and Vapors from Poisonous Mines, Wells, or Privies, from the 
Fumes of Charcoal, from Common Burning Gas and from the Gas of Bituminous 
and Anthracite Coal. Asphyxia from Narcotic Poisons— What to Do. Foreign Bodies 
in the Eye, Ear, Throat, Windpipe and Nostrils. Sunstroke and Heat Prostration — 
Prevention and Treatment. 

21-32. 

CHAPTER V. 
Accidents and Emergencies. — Concluded. 

Frost-Bite —The Fingers, Toes, Nose, Ears and Lips, the Parts Most Frequently Attacked 
— Treatment. "Frozen to Death" — Its Meaning. Chilblains — Description and 
Treatment. Accidents from Lightning — Shock and Burns from It — Treatment. 
Spitting of Blood. Poison Vine Eruption — Treatment. Whitlow or Felon — 
Appearance and Treatment. Boils and Carbuncles. Earache— Treatment. Headache 
— Varieties— Nervous and Congestive, etc. Toothache and the Way to Prevent It. 
Faceache— Treatment. 

33-42. 

CHAPTER VI. 
Poisons and Their Antidotes. 

What Constitutes a Poison ? Mode of Action of the Different Poisons— Acid, Alkaline 
Mineral and Vegetable Poisons — Corrosive and Non-Corrosive Poisons. General 
Instructions, Emetics with Chemical and Physiological Antidotes, the Sheet Anchors — 
Acetic, Citric, Muriatic, Nitric, Oxalic, Sulphuric, Tartaric, Carbolic and Hydrocyanic 
(Prussic) Acids. Caustic Soda, Caustic Potash (Common Lj'e), Lime and Lunar 
Caustic. Tincture of Iodine. Alcohol. Arsenic. " Rough on Rats." Lead. Mercury. 
Antimony. Ammonia or Hartshorn. Nitrate of Potassa (Saltpetre). Copper, 
Phosphorus and Sulphate of Zinc. 

43-54. 

CHAPTER VII. 

Poisons and Their Antidotes. — Concluded. 

Vegetable Poisons. Narcotics. Stramonium. Opium and Its Alkaloids. Belladonna 
Hyoscyamus or Henbane— Strychnine and Nux Vomica— Digitalis— Aconite— Lobelia 
(Indian Tobacco). Tobacco or Nicotine Poisoning— Savine— Poisoning by Eating 
Poisonous Meats, Fish, Oysters and Poisonous Mushrooms and Toadstools. A Complete 
Table of Poisons and Their Antidotes Appended. 

55-77. 



CONTENTS. XI 

CHAPTER VIII. 
Materia Medica and Therapeutics. 

Pharmacy— The Derivation of Medical Agents. Hygienic — Mechanical — Imponderable 
and Medical. Blood-letting by Venesection, Cupping and Leeches. Light, Heat, Cold 
and Electricity. The Modus Operandi and Application of Medicines. The Different 
Methods Given, and the Circumstances Modif3 T ing Their Action Fully Described. 
Apothecaries' Weight aud Measures. Abbreviations and Symbols Used in Writing 
Prescriptious and in Medicine Generally. The Classification of Medicines According 
to Their Action on the Animal Economy, Fully Defined. Diuretics — Emetics — Tonics — 
Astringents — Diaphoretics — Narcotics — Emmenagogues — Cathartics — Antacids^-Anti- 
Spasmodics — Irritants — Demulcents — Anthelmintics — Anaesthetics — Spinants — Altera- 
tives — Antiseptics, etc. 

78-85. 

CHAPTER IX. 
Materia Medica and Therapeutics. — Concluded. 

Quinine, Its Origin, Discovery and History. The Use and Abuse of Quinine. Drs. A. K. 
Hill and C. A. Bryce on the Subject. Permanent Deafness as a Result of Over Doses. 
Its Value in Dyspepsia and Catarrh of the Stomach. Its Employment in Checking 
Tonsilitis, Inflamed Breasts, Pneumonia, Pleurisy and Other Inflammatory Processes- 
Peruvian Bark and Its Alkaloids : Quinine and Cinchonidia Specifics for Fever and 
Ague and Malarial Poisoning in General. The Value of Quinine in Blood Poisoning 
from the Absorption of Pus or Dike Septic Matters. 

86-9I. 

CHAPTER X. 
Genito-Urinary Tract. 

Woman's Woes— Menstruation. The Proper Time for the Menses. The "Change of 
Life " or Menopause. Causes and Utility of Menstruation. The Bible and the Mosaic 
Law on the Subject. The Source of the Menstrual Fluid. Disorders of Menstruation 
—Headache, Absence of Menstruation, Painful and Excessive Menstruation. Advice 
to Mothers in Regard to Their Daughter's First Menstruation. The Causes for the 
Non-appearance or Cessation of the Menses. The Use of Female Pills. Chlorosis or 
Green-Sickness in Young Girls— Its Causes and Treatment. Sitz or Hip Baths and 
How to Take Them. How to Relieve Painful Menstruation. Vicarious Menstruation 



and Its Treatment. 



92-99. 



CHAPTER XI. 
Genito-Urinary Tract. 

Leucorrhcea or the " Whites." Its Causes, Source and Evil Consequences. Backache, Loss 
of Appetite, and General Exhaustion Sure to Follow its Neglect. Leucorhcea Often 
the Cause of Inducing Gonorrhoea in the Male. A Frequent Factor of Domestic 
Unhappiness and Misery. Catarrh of the Womb as a Cause of Leucorrhcea- 
Successful Home Treatment. Leucorrhcea in Children— Its Origin, History and 
Infallible Treatment. 

IOO-IO3. 



Xll CONTENTS. 

CHAPTER XII. 
Genitourinary Tract. 

Gonorrhoea in the Male, Its Cause, Origin and History. Women Frequently Give Gonor- 
rhoea Without Having the Disease Themselves— through Leucorrhoea. Professors 
Taylor and Bumstead on the Subject. Safeguards Against Gonorrhoea. The Great 
Need of Cleanliness— Symptoms— Treatment. Danger Resulting from Improper or 
Very Strong Injections. Serious Consequence from the Excessive Employment of 
Copaiba. Many Invaluable Receipts. — Complications — Sequela — Inflamed Eyes — 
Swelled Testicles— Buboes— Strictures, etc. 

IO4- 1 19. 

CHAPTER XIII. 
Genito-Urinary Tract. — Gonorrhcea in the Female. 

The Parts Affected. The Laws of Cleanliness Not to be Overlooked— Treatment— Gonor- 
rhcea in Women is More Quickly and Easily Cured Than in the Male. Constitutional 
or Internal Remedies Seldom Necessary — Infallible Receipts and Directions. 

120-123. 

CHAPTER XIV. 
Genito-Urinary Tract. 

The Sexual Relation — Society's Serious Mistake — Maid and Lover-^Man and Wife — The 
Very Serious Consequences of Violating the Laws of Nature — A Lengthy Extract from 
the Excellent Work Entitled "Lessons in Gynaecology," by the Eminent Wm. Goodell, 
A. M., M. D., Professor of the Diseases of Women, etc., in the University of Pennsyl- 
vania in Philadelphia. 

I24-I34. 

CHAPTER XV. 
Genito-Urinary Tract. — Lactation. 

Wet Nursing— Disadvantages to a Healthy Woman if She Does not Nurse Her Infant. 
Bodily Disease— Sore Breasts— Cancer or Uterine Diseases Often Result if Nursing 
is Neglected. Mechanical Means. Diet and Medical Agents, Which Promote the 
Secretion of Milk. How to Check an Over-Abundant Secretion of the Lacteal Fluid. 
The Influence of Coffee on the Mammary Secretion. Treatment of Sore Nipples. 
Different Kinds of Nipple Shields. 

I35-H2. 

CHAPTER XVI. 
Digestive Tract. 

Food for the Sick and Its Administration— Many Valuable Receipts for the Invalid- 
Cookery for the Sick. Room— Broths— Soups— Gruels, etc. The Use and Abuse of 
Alcoholic Stimulants— A Pound of Beef and a Pound of Eggs— How to Vary the Diet 
—Tuberculous and Other Germs in the Milk— Boiling as a Safeguard— A Warning 
Against So-called Infant Foods. The Opinion of Ex-Provost Pepper. 

143-156. 



CONTENTS. Xlll 

CHAPTER XVII. 
Digestive Tract. 

Our Digestion — Where and How Our Food is Digested and Absorbed Into the Blood. The 
Function of the Digestive Fluids. Dyspepsia and Its Causes. The Proper Diet for 
Dyspeptics. Treatment of Indigestion. Gastralgia or Cramp of the Stomach. An 
Enumeration of the Causes. The Passing of Gail-Stones. Treatment of Cramp. 
Habitual Constipation, Causes and Treatment. 

I57-I7L 

CHAPTER XVIII. 
Pure Air and Ventilation. 

Pure Air, and Its Effects on Health. Diseases Resulting from Bad Ventilation and Impure 
Air. Bad Air Compared to Soiled Water. Pure Air in the Bed-Room. Methods of 
Ventilation. The Need and Use of Sunshine. The Proper Care of School Houses. 

172-177. 

CHAPTER XVIII.— Continued. 
Contagion and Disinfection. 

Microbes in the Water and Atmosphere — Sterilization and Disinfection. What Are Anti- 
septics. Principal Agents Used for Disinfection. How Infectious and Contagious 
Diseases are Propagated and Remedied. The Prevention of Scarlet and Typhoid 
Fevers— Diphtheria, Cholera and Other Infectious Diseases. How to Disinfect Rooms, 
and Cellars. 

178-183. 

CHAPTER XVIII.— Concluded. 
Home Nursing and Care of the Sick. 

184-187. 

CHAPTER XIX. 
Diseases of Children. 

Part 1.— Intestinal Worms in Children. They May Cause Serious Sickness and Death 
Six Kinds of Worms. The Symptoms They Produce. The Cause of Worms. How to 
Recognize the Presence of Worms. How to Successfully Treat Them. Improper 
Worm Mixtures Frequently Do Harm. Tape Worms— Their Prevention and Removal. 

188-I9I. 
Part 11.— Nightmare, or Night Terrors of Children. 

192-194. 
Part hi. — The Mother's Medicine Box of Home Remedies. 

I94-I96. 
Part iv.— Cholera Infantum. Complete Instructions as to Prevention, Causes and 
Treatment. 



XIV CONTENTS. 

197-201. 
Part v.— The Care of Infants During Hot Weather. Home Treatment of Colic. Consti- 
pation. Convulsions or " Fits " in Children— Causes and Treatment. 

201-205. 
Part vi.— Laryngitis or Croup of Children. 

205-208. 
Part vii.— Whooping Cough. 

208-2IO. 
Part viii.— Chorea or " St. Vitus Dance." 

2IO-2I3. 

CHAPTER XX. 
Special Medical Diseases. 

Pharyngitis, Tonsillitis or Quinsy— Clergyman's Sore Throat or Catarrh of the Throat- 
Catarrh of the Nose— Asthma, Its Causes and Treatment. Appendicitis. Bronchitis- 
Pneumonia— Pleurisy or Pleuritis— and Their Treatment. Pulmonary Consumption, 
Its Origin, Cause, Prevention and Treatment. 

214-238. 

CHAPTER XXI. 

Special Medical Cases. 

Sick Headache and Its Treatment — Convulsions, Epilepsy or Falling Sickness — Hem- 
orrhoids or Piles and How to Relieve Them — Sciatica, Its Cause and Treatment — 
Diabetes and Proper Diet for the Diabetic — Diarrhoea in Grown People and 
Dysentry, and Their Treatment. Bright's Disease— Aphasia — Intermittent Fever or 
"Fever and Ague," and Malaria, Its Cause, Prevention and Cure — La Grippe — Scarlet 
Fever, Its Origin, History, Prevention and Treatment— Typhoid and Typhus Fevers 
and Asiatic Cholera and Their Prevention — Delirium Tremens, Hysteria, Neuralgia, 
Gastritis, Rheumatism, Nettle Rash, Erysipelas, and Peritonitis and Their Treatment 
— Scabies or " Itch," and Pediculi, or Dice, and How to Get Rid of the Same— Diph- 
theria and Measles. 

239-302. 

CHAPTER XXII. 
Miscellaneous. 

Insomnia, Its Cause and Treatment — Fear As a Factor of Disease and Death— The Blood, 
the Quantity in a Human Being— The Corpuscles and Circulation— The Function of the 
Blood— Vital Temperature and the Use of the Fever Thermometer— Local and Atmos- 
pheric Temperature— Baldness and How to Take Care of the Hair — Many Valuable 
Hair-Tonics— How to Darken the Hair— Foul Breath and How Remedied— Sper- 
matorrhoea— Its Causes and Consequences— Why Parents and Others, Should Guard the 
Children in Their Charge Against Evil Habits— Sexual Excesses and What They Entail- 
How to Make All Kinds of Poultices— Abortion — The Awful Crime and Endangerment 
to Life of Criminal Abortion— Doctor Cathell's Emphatic Denunciation on the Sub- 
ject—The Best Anti-fat Remedy— How to Cure Sweating Feet and Correct Foul Odor— 
The Way to Remove Freckles— Many Invaluable Health Notes. 

303-3 2 9. 



CHAPTER I. 

Accidents and Emergencies in General. 

Introductory Remarks. Shock and its Treatment. How to Carry an Injured Person. 
Fractures— A Full Description of the Different Kinds of Fractures. What to Do until 
Medical Assistance can be Obtained. Dislocations— How to Detect Them. Sprains — 
Their Importance and Treatment. 

There is nothing so important in the event of an accident or 
other emergency as that some person with coolness and sufficient 
knowledge should assume command and begin to set things 
straight. It will be found, as a rule, that the simplest things, 
and usually the most useful, are neglected, while there is a 
disposition to rely upon cumbrous appliances, often of disadvantage, 
and sometimes positively hurtful. The object of the writer is to 
present in a compressed form, for easy recollection and ready 
reference, a few suggestions as to what should be done in certain 
cases of emergency, until the arrival of skilled professional 
assistance. It is not saying too much, perhaps, that what is to 
be done to give relief or save life, in the great majority of cases, 
must be done by the unskilled before the aid of a physician can 
be procured. It has been truly said, " for want of timely care, 
millions have died of medicable wounds. ' ' 

As far as possible, the use of technical terms will be omitted, 
although when necessary they will be used, with a brief definition ; 
but the writer would respectfully suggest, that, whenever possible, 
the scientific term should be remembered and used, instead of the 
popular expression for the same thing. A scientific term, the 
world over, means but one thing ; while a popular expression, in 
one place, means one thing, and in another, two or three things ; 
and, possibly, nothing at all. 



2 ACCIDENTS AND EMERGENCIES IN GENERAL. 

ACCIDENTS IN GENERAL. 

Accidents always, if there are people about, cause crowds to 
gather around the victim. Trie first thing to be done is to disperse 
them ; or, at least, get the people to keep away from the injured 
person. A space of at least ten feet on every side should be kept 
wholly free from ever} T body except the one or two in charge of the 
operations for relief. If others are needed for a moment to assist 
in some special duty, as lifting, removing of dress, etc., the}' can 
be specially selected from the crowd, and, having been of service, 
and not further needed can immediately retire. In numerous 
instances, the writer has seen persons, who were seriously injured, 
so closely surrounded by a dense mass of ' ' relatives ' ' and 
' ' friends, ' ' that it was impossible for the physician to freely use 
his arms. The kindest thing a by-stander can do, is to insist upon 
a free space as large as suggested, and select from the crowd 
persons to hold themselves in readiness to start for whatever the 
physician or the individual in charge of the case may require. 
To show how little real interest the inner circle of the crowd 
usually takes in the restoration of the patient, it will often be 
found that it is almost impossible to get one of them to run an 
errand in the interest of the sufferer. 

If the person has been thrown from a carriage, injured by a 
fall from a height, blow or other cause, while there may be no 
fracture, or other external injury evident, the nervous system has 
received what is called a "shock." As is commonly said, the 
person is " faint." 

A person suffering from such symptoms should, if possible, 
be placed flat on the back, with the head, neck, and shoulders 
slightly raised. The limbs at the same time, should be 
straightened out, if practicable ; so that the heart, already 
depressed in action, m.&y act at as little disadvantage as possible. 
The collar, and everything else calculated in any way to impede 
the circulation toward the head, or obstruct the movements of the 
chest, should be loosened or removed. If the injury is slight, 
re-action will soon come on after giving the person a sip of cold 
water ; brandy and water (teaspoonful in a tablespoonful of cold 
-water) every couple of minutes ; or aromatic spirits of ammonia 



ACCIDENTS AND EMERGENCIES IN GENERAL. 6 

(twenty drops in a tablespoonful of cold water) every couple of 
minutes. Gentle frictions to the extremities, a few drops of 
cologne water on a handkerchief to the nostrils ; if the weather 
is hot, the use of the palm-leaf fan ; hot flannels to the limbs 
and epigastrium (pit of the stomach); are all likewise useful in 
assisting re-action. 

By this time, should a surgeon have arrived, he will examine 
and decide upon the special nature of the injury, and inaugurate 
measures of special relief. Should he not have appeared, and it 
Is deemed best to remove the patient to the hospital, or his home, 
a stretcher should be secured, or a substitute, in the shape of a 
settee or shutter, provided. The injured person should then be 
gently slipped on, seeing that the body is supported as much as 
possible along its length, something thrown over or held over the 
face, to prevent, as much as practicable, the uncomfortable feeling 
of being stared at in passing along. Four persons of uniform 
gait should gently lift the stretcher and slowly carry the person to 
his destination. In most cities, appliances for carrying injured 
persons are required to be kept at the station-houses, and can be 
obtained, on application, as well as the services of a good 
policeman. The authority of the latter is almost invaluable in 
keeping away the crowd referred to, and in securing useful 
attention in conveying the person through the streets. If the 
person is to be taken to the hospital, a dispatch from a police 
station will secure from most of them, free of charge, an 
.ambulance, with competent persons to take charge of the injured 
individual. 

FRACTURES AND DISLOCATIONS. 

It is often evident to the bystander that a fracture or 
dislocation exists, without knowing what can be done in the 
interval which must elapse before the arrival of professional 
assistance. Of course no one but a very ignorant and bold man 
"would attempt to do more than make the sufferer comfortable in 
the meantime. 

In instances of suspected fracture or dislocation of the lower 
extremity, the injured parts should be placed in a comfortable 
position, and as well supported as possible, to prevent the 



4: ACCIDENTS AXD EMERGENCIES IX GENERAL. 

twitchings of the leg from the spasmodic action of the muscles of the 
injured extremity. If necessary to remove the patient to his or her 
home or the hospital, from the spot where the accident happened, 
the arrangement of the limb is better made before the patient has 
been placed on the stretcher or substitute, and a splint of any 
description applied, for obvious reasons. If found necessary to 
carry the injured person some distance, and a litter for the purpose 
cannot be had, the arrangement of the fractured limb against the 
other, and kept there by handkerchiefs, is often of great comfort 
to the sufferer. 

If the general character of the injury is evident, in sending 
for the surgeon it is best to tell the messenger, so that, as far as 
possible, the necessary appliances can be provided before leaving: 
the office. 

In the meanwhile, under no circumstances, should the 
bystanders be permitted to handle the affected part beyond what 
is absolutely necessary. As a general rule, a much longer time 
than is commonly supposed, by most people, may pass between 
the occurrence of the accident and the arrival of the surgeon 
without serious injur}' to the patient, or ultimate disadvantage to 
the fracture. Many persons, thinking that the broken bone must 
immediately be ' ' set, ' ' are apt to accept the services of the first- 
person arriving, asserting himself qualified to do it. Such an 
individual necessarily makes a more painful examination than is 
necessary, applies the splint — perhaps not at all the most useful — 
which the surgeon, arriving later, is obliged, out of consideration 
for the condition of the sufferer, to acquiesce in. 

If the injury is to the upper extremity, the part should be 
placed in a supporting sling, and kept in a comfortable position. 
Sometimes, owing to the severity of the injur}* or the condition 
of the general health of the person at the time, symptoms of shock, 
from the mildest expression, to insensibility are observed. 

As we are on the subject of fractures it would not be out of 
place here to give a definition of the word, fracture, and an 
explanation of the many kinds of fracture. 

A fracture is the division of a bone into one or more pieces,, 
from violence. 



ACCIDENTS AND EMERGENCIES IN GENERAL. O 

A fracture is simple when there is no wound communicating 
Tvith it ; compound when there is such a wound ; transverse when 
the line of fracture lies across the bone ; oblique when it slopes ; 
longitudinal when it is more or less parallel to the long axis ; 
comminuted when broken in several fragments ; complicated when 
there is a laceration of an artery or joint, or other additional 
injun-. A "green stick " or " willow " fracture, is an incomplete 
fracture, in which some of the bony fibers have given way and 
the rest have bent, but have not broken. An impacted fracture 
is one in which one fragment is driven into and fixed into the 
other. If the same bone is broken at two different places, or more 
than one bone is broken in the same limb, it is called a multiple 
-fracture. If cracked only without displacement or separation of 
^periosteum, it is called a fissure. 

DISLOCATIONS. 

A dislocation is the removal of the articulating portion of a 
"bone from that surface to which it is naturally connected. They 
Tesult from force applied in such a way as to dislodge the surface 
of one bone from another ; what is called the head of the bone 
slipping off into a neighboring depression. Of course, the 
ligaments binding the parts together, are torn and stretched, 
beyond the point of slight elasticity found in such tissues and the 
^adjacent parts are badly contused. 

No directions can be given for detecting a dislocation. It is 
sometimes evident to the sight, but the possibility of a fracture 
anust be remembered, and the patient made comfortable, without 
Jia?idling the injured parts until aid can be summoned. A 
-dislocated joint is always afterward a weak one, and a small part 
of the force originally used will produce a return of the trouble. 

SPRAINS. 

In a sprain, the joint is twisted, so that the ligaments binding 
the parts together are severely stretched or even torn, with 
consequent violence to the delicate lining of the joint. A sprain 
is understood to be short of displacement of the surfaces of the 
bones, which would be a dislocation. 



b ACCIDENTS AND EMERGENCIES IN GENERAE. 

They most frequently occur at the wrist and ankle-joints. 
The injury is rapidly followed by inflammation of the joint and 
adjacent parts. Not only is the joint directly weakened by the 
injury, but if there is a tendency to rheumatic disorders, or the 
constitutional leaning known as strumous, no little future trouble 
often follows. 

There is, of course, great pain, and if it is the ankle or wrist 
joint injured, often nausea. The tendency to inflammations, 
should be discouraged by resting the whole body, and keeping; 
the sprained joint elevated. Cold water in the shape of a " drip >p 
should be used plentifully until the opinion of a physician can be 
obtained. Complete rest must be kept up until the inflammation 
shall have passed and the probably torn ligaments been restored™ 
Later, stimulating liniments can be used. Often a fracture of the 
shaft of a bone results in a speedier restoration than the spraini 
of an ankle-joint, especially if the proper care is not observed,, 
in case of such an accident. Hops, vinegar and soap, when 
boiled together, is an excellent domestic application for sprains. 
I prefer the following liniment — soap liniment, tincture aconite 
root and chloroform of each, one ounce, to be applied every 
few hours. 



CHAPTER II. 

Accidents and Emergencies. — Continued. 

Collapse or Shock in Grave Accidents and What to Do — Full Instructions. Syncope or 
Fainting. Burns and Scalds, from Fire or Hot Water and Steam. Burns by L,ime, 
Caustic-Potash and Other Alkalies. Burns by Acids— Sulphuric (Oil of Vitriol) — Nitric 
(Aqua Fortis)— Etc. Baking-Soda— White of Eggs — Lime-water and Linseed Oil 
(Carrou Oil). Splendid Home Dressings. 

Mild forms of shock (or collapse, as it is sometimes called) are 
often, by the non-professional, confounded with fainting (syncope). 
As far as symptoms are concerned, the affections are analagous, 
varying in degree and duration, rather than in variety, the 
duration of fainting being usually much shorter. 

Life may be destro3^ed by certain agencies as a blow upon 
the "pit of the stomach," or a sudden and powerful emotion of 
the mind, and no visible trace be left in any part of the body. 
This is called " death from shock." This is the extreme result 
of shock. Usually the patient lies in a state of utter prostration. 
There is a pallor of the whole surface ; the lips are bloodless and 
pale. The eyes have lost their lustre, and the eyeball is usually 
partially covered by the drooping upper lid. The nostrils are 
usually dilated. The skin is covered with a cold, clammy 
moisture, often gathered in beads of sweat upon the forehead. 
The temperature is cold, and perhaps the person shivers. The 
weakness of the muscles is most marked ; as the phrase is, ' ' the 
patient is prostrated." The mind is bewildered, often insensibility 
occurs, unless aroused : and in many cases, nausea and vomiting. 
In extreme cases, the nausea and vomiting are not so apt to occur. 

Sudden and severe injuries, particularly if extensive in 
character, and involving a large amount of texture, cause shock. 
Burns — especially of children — extending over a large extent of 
surface, even if not extending to a great depth, are often followed 
by shock, and this complication requires often the earliest attention. 

Certain poisons, as tobacco, and tartar emetic, act in this 
manner, depressing the system. So does a current of electricity, 
as is seen in the effects of lightning. 



8 ACCIDENTS AND EMERGENCIES. 

Loss of blood produces or aggravates shock. Hence a slight 
injury, with much loss of blood, may be attended with more shock, 
than a comparatively more severe injury without the loss of blood. 
Debility favors the influence of shock. A weak system is more 
easily impressed by it, aud, as should be expected, re-action from 
its effects is longer in taking place. 

As the vital powers of life decline, from engrafted or 
natural causes, there is less power available as a reserve to meet 
contingencies. In youth there is an available fund of this kind ; 
in the adult the resources of the system may be equal to the task 
of ordinary maintenance, but in the aged, as said before, there is 
much less ability to deal with sudden losses of strength. The 
aged, therefore, are slow to rally from the effects of shock. The}?- 
have more power of resistance than the young. The shock does 
not readily make an impression, as it does in the young, but when 
it does, the impression endures. In the young the impression is 
more easily made, but sooner subsides. 

Treatment of shock should consist in first placing the patient 
as flat on his back as possible with the head raised not over an inch. 
This is an important point in cases of ordinary fainting, and 
whenever the vital powers are depressed, stimulants are required. 
The aromatic character of brandy enables it to be retained by the 
stomach when whiskey and other forms of alcohol are rejected. 
A teaspoonful in a tablespoonful of water every minute, until six 
or eight have been taken, is the best way to give it. If the 
temperature of the body is raised by it, and there seems a revival 
of the action of the heart, enough brandy has been given. 
Twenty drops of the aromatic spirits of ammonia in a teaspoonful 
of water may be given every couple of minutes, until four or five 
doses have been taken. The application of heat to the extremities 
and ( ' pit of the stomach ' ' is very useful. Flannels, wrung out 
in hot water property wrapped up, should not be neglected. In 
some households, a tin can, somewhat concave on one surface, to 
fit the curvature at that point, and with a stopple in the upper 
surface for the introduction of the hot liquid, can be usefully 
employed for applying heat to the epigastrium ( " pit of the 
stomach "). Mustard plasters to the same places are often used, 



ACCIDENTS AND EMERGENCIES. 9 

~but they are far inferior to heat for the purpose, if that can be 
applied, and so apt to blister, thereby making it impossible to use 
anything else on the surface, that some reluctance is felt in 
advising them. Nausea and vomiting often occur in shock, and 
can best be allayed by getting the patient to swallow whole, 
small chips of ice. Ice, by the wa}', can be easily chipped by 
standing the piece with the grain upright and splitting off a thin 
edge from the point of a pin. 

Ammonia (smelling salts), applied to the nostrils, is often 
useful ; and cologne, on a handkerchief, is often pungent enough 
to be of service. A physician (and he alone) will no doubt resort 
to hypodermic injections of drugs to revive the patient. The 
drugs used in this way and found to be of great efficacy are : 
morphine, nitro-glycerine, digitalis, strychnia, etc. Whiskey also 
may be administered itypodermically to bring on the re- action 
which is necessary for the revival of the patient. 

SHOCK FROM BATHING IN OR DRINKING COED WATER. 

In the hot weather, cases often occur where death or great 
prostration ensues from drinking ice water, or bathing in cold 
water, while the body is exhausted from heat or exercise. The 
same thing happens to animals under similar circumstances. Cold 
water in hot weather, if the person is heated, should always be 
drunk in small quantities at a time. If not, although neither 
death nor prostration may follow, a troublesome derangement of 
the digestive tract is likely to ensue, often laying the foundation 
for other troubles. 

When the body is heated, or exhausted, a bath in cold water 
ought never to be taken. A sponge bath will answer, until the 
vigor of the body has had time to be restored. 

These troubles can be referred to shock, and should be 
j>ro7nptly treated as such, according to the given directions. 

SYNCOPE OR FAINTING. 

Persons often faint without any proportionate cause. Debility 
of the nervous system favors it. While the writer would not like 
to say that the tendency to swoon can be intentionally acquired, 
he is compelled to think it can be unintentional!} 7 perpetuated 



10 ACCIDENTS AND EMERGENCIES. 

under many circumstances. The treatment usually followed, is 
perhaps, the best ; but people are apt to raise the head of the 
patient. Kven in carrying a person to the bed or sofa, it should 
be kept lower than the rest of the body. Indeed, there is no 
better restorative in such cases than such a relative position of the 
extremities. Should the person be sitting in a chair at the 
moment, do not remove him. but stand behind the chair, reach 
the hands over in front, so as to grasp the sides of the back of 
the chair, take a step backward to give room, and then slowly 
depress the back, supporting the head until the floor is reached. 
An assistant, by holding to the dress over the knees, will prevent 
lateral slipping off from the seat of the chair. It is so rapidly 
and easily done, besides so effective in its operation that little else 
remains to be done. Usually the back of the head of the 
patient scarcely reaches the floor before consciousness returns. 

burns. 
There are no more frequent, distressing, and dangerous 
accidents than those which result from burns ; they cause great pain 
often amounting to agony, local injuries of a most serious 
character, and permanent constitutional derangement, even if 
death does not immediately or quickly ensue. The first rule to 
be observed in the event of the clothes catching fire, is to avoid 
running away for assistance, as the motion will only fan the 
flame, and increase the evil. Presence of mind in the sufferer is 
rare on such an occasion, but the best plan is to lie down and roll, 
on the floor, screaming of course, for assistance. Whoever 
answers the call should snatch up a rug, or piece of carpet, or 
other woolen article, and roll the person in it, so as to stifle the 
flames, leaving only the head out for breathing. If no carpet or 
rug can be had, then take off your coat and use it instead. Keep 
f he flame as much as possible, from the face, so as to prevent the 
entrance of the hot air into the hmgs. This can be done by 
beginning at the neck and shoulders with the wrapping. If the 
burn or scald involves considerable surface, symptoms of shock are 
observed, from the extreme of mere weakness to that of utter 
prostration. This at once requires prompt attention and a few 



ACCIDENTS AND EMERGENCIES. II- 

drops of aromatic spirits of ammonia in water, or a little brandy, 
should be given every few minutes until a return of the strength 
is seen. A burn, superficial as far as depth is concerned, but 
covering a large surface, especially in the case of small children 
and aged people, is usually considered more dangerous, as far as 
life is concerned, than a burn smaller in extent but deeper and 
more complete. Never mind how slight the injury appears, if 
there is reason to suppose that the heated air or steam has been 
inhaled^ no time should be lost in obtaining the opinion of a 
physician as to the result of the injury to the throat and lungs. 

TREATMENT. 

If the burn or scald is slight in character, one of the best 
applications is the water dressing. This consists of several 
thicknesses of wet towels. They must be dipped in cold water 
(or water containing some baking soda) squeeezed out, and 
changed even- sixty seconds. If not changed, the wet towels 
really act as poultices to the part, inviting what we should try to 
prevent. In a short time after the pain shall have moderated, one 
of the best things for use, and readily procured, is a dressing of 
pure hog's lard. The great object is now to exclude the air from 
the blistered or raw surfaces, and it is a usual plan to cover them 
with flour, and then wrap them in wadding, or cotton wool. A 
good application is either of the above substance saturated in 
carron oil which is a composition of equal parts of lime water and 
linseed oil ; this is extremely cool and soothing, and it greatly 
assists the healing operation ; it should not be disturbed for some 
days, unless the discharge should be great, and the wounds 
painful, in which case a fresh application of the same should be 
prepared, and put on immediately on the removal of the other. 
If the burn or scald, particularly the latter, is superficial in 
character, a simple and useful dressing is the application, by a 
brush, or a soft wisp of old muslin, of the white of egg to the 
injury. As soon as the first layer dries, another should be used. 
In superficial burns and scalds, this treatment is especially grateful. 

A lather of soap from the shaving-cup, applied by the brush, 
in the same way, is often followed by immediate relief. These 



12 ACCIDENTS AND EMERGENCIES. 

substances appear to protect from the action of the air the irritated 
nerves beneath. As before said, do not apply "cotton" to the 
injury, as sooner or later it increases the pain, and without having 
done any special good, besides it is difficult to remove. 

If a physician has been sent for, it is best not to make any 
domestic applications to the burned parts. Such things frequently 
prevent him from using those better adapted to the wants of the 
person, and keep him, too, from forming a correct estimate of the 
real extent of the injuries. When the effects of the burn or scald 
extend deeper, involving the sub-cutaneous tissue, or even the 
parts beneath that, as the muscle, other considerations must not 
be overlooked. There probably will be more shock. The portion 
whose vitality has been destroyed by the burn cannot do otherwise 
than become detached from the uninjured parts beneath, thrown off 
in the shape of shreds or larger masses, during the process of 
sloughing. After water dressing has given relief to the part, and 
"this is sometimes sooner secured by adding laudanum (tincture of 
opium) to the water a s} T stem of poulticing should be commenced. 
After being used for a short time, a mark of well-defined separation 
is seen at the junction of the burned and unburn ed parts. The edge 
of this dead portion often falls away, like a piece of wet buckskin, 
showing, except at the edges, a union of the dead and living parts. 

This process of separation continues for some time, attended 
with such profuse discharges that the poultices must be chayiged 
several times a day to preserve neatness, but after a while the 
■entire mass lies loose, attached only at the centre to a raw 
suppurating surface below. A short time after the whole mass 
becomes detached and is removed. Then at the edges and surface 
of the uninjured parts a process of filling up the wound by 
' ' granulation ' ' must commence. The newly formed substance 
begins first to be deposited at the edges of the wound, generally 
reducing the area. This process, in such a wound, the result of 
a burn, is much less rapid than might be supposed by the unpro- 
fessional, and is attended with much suppuration (making of pus.) 

Whenever the destructive process of suppuration goes on in 
the body, from whatever cause, there is exhaustion of the strength. 
'This must be combated by a judiciously selected diet ; and 



ACCIDENTS AND EMERGENCIES. 13 

sometimes by appropriately selected tonics. Often the surface 
undergoing repair is benefited by local applications ; these can 
only be rightly chosen by a physician, so nothing need be said 
about them here. 

As remarked above, in burns beyond a certain degree of 
destruction, the process is one of repair rather than restoration. 
Instead of the destroyed portion being replaced the reparative 
material is of such a character that it undergoes contraction ; and 
great deformity may result from its dragging effects upon adjacent 
healthy parts. These effects may often be mitigated in extent 
but can not be wholly prevented. Thus, if the arm, at the elbow, 
is burned or scalded, so that a scar results, the contraction of this 
tissue will often draw up the forearm to a right angle, from which 
it can not be straightened. A burn or scald at the front of the 
neck is often followed by a dense white scar, which contracting, 
draws the chin down toward the chest, and the lower lip down 
toward the chin, ending in the greatest deformity. The medical 
attendant is sometimes unjustly censured for these things. 

From what has been said, it must be observed that burns and 
scalds practically differ but little from each other. Scalds are 
usually more confined to the outer cuticle, unless the substance 
containing the heat is viscid in character, as oil, pitch, etc., and 
does not rapidly run off the part with which it came in contact. 
As far as popular assistance is concerned, the two may be regarded 
as presenting no essential difference. 

Cloths wet with cold water may be kept constantly applied, 
and if the destruction of the skin is not too complete, nothing 
more will be required. 

BURNS BY LIME, CAUSTIC POTASH, AND OTHER ALKALIES. 

As a rule these are troublesome, since there is not only 
removal of the cuticle, superficial skin, but destruction of the 
soft parts below. I^ime is a powerful alkali, and rapidly destroys 
the parts with which it comes in contact. It is useless to attempt 
to pick it off, for the fingers remove no more than they get hold 
of, so an application should at once be made of something to 
counteract the alkali, or form a comparatively harmless preparation. 



14 ACCIDENTS AND EMERGENCIES. 

Vinegar diluted with water, the acid in lemon juice or any other 
dilute acid, will answer as a direct antidote. These things do not 
undo what has been done, the} 7 only prevent further mischief. 
The portion of the tissue already destroyed, must separate as if it 
iad been destroyed by heat in the case of a burn or scald ; and 
must be aided by the same means, heal in the same manner, and 
be followed, of course, by the same ultimate contraction of the 
reparative material. What has been said about the alkali known 
as lime, may be said about the other alkalies : potash, soda, 
.ammonia, etc. 

BURNS BY ACIDS SULPHURIC ACID (OIL OF VITRIOL ) , 

NITRIC ACID, (AQUA EORTIS, ) ETC. 

As alkalies destroy the living tissues they come in contact 
with, so will acids of sufficient concentration. In such cases, 
application of water will dilute them beyond their capacity to 
inj ure. Alkalies applied neutralize acids into harmless preparations. 
Common earth, gathered almost anywhere, applied in handfuls, 
contains alkali enough of one kind or another to entitle it to the 
consideration of being one of the best (and at the same time 
most easily secured) applications in cases of burns by acids. 

In all burns and scalds exclude the air as soon as possible. 
This is generally more readily accomplished by wrapping the 
burned part with gauze or cotton soaked in oil. Cloths wrung 
out of a solution of ' ' baking soda ' ' or boric acid are said to relieve 
the pain promptly. A dressing of flour can usually be obtained 
at once, and answers as a temporary dressing. 

The dressing should be allowed to remain on as long as 
possible. All blisters should be pricked and their fluid contents 
allowed to escape. Burned fingers should not be allowed to touch 
each other. 

In the treatment of any burn the utmost cleanliness should 
be observed. Maturation from burns is no more necessary 7 than 
from any other wound. The} 7 should be dressed antiseptically. 
This can be easily accomplished by having the oil used, slightly 
carbolized. Carbolized or iodoform or bichloride gauze should 
be used. 



CHAPTER III. 

Accidents and Emergencies. — Continued. 

A.11 Kinds of Wounds and Contusions or Bruises — How to Treat Them. Bleeding from the 
Mouth or Rectum in Case of an Injury. Mashed Fingers or Toes. How to Stop 
Bleeding from Wounds. Antiseptic Agents in Wounds. What to Do where the Iyiings 
or Bowels Protrude. The Extraction of Needles and Splinters. What to Do in Bites 
of Venomous Serpents. How to Treat the Bites of Insects. Valuable Suggestions in 
the Bites of Dogs or Other Animals. Gunshot Wounds, etc. 

Iii studying wounds we will adopt the classification customary 
in works on surgery, viz., contusions, contused, lacerated, 
punctured, poisoned, incised and gunshot wounds. 

Contusions are what are usually known as bruises and almost 
all wounds of the soft tissues caused by blows. They are 
sometimes very painful, and often followed by discoloration, due 
to the escape of blood under the skin from the small vessels of a 
part. A black eye is a familiar example of this sort of an injury. 
They are sometimes very simple, as in the illustration just given. 
Such contusions are best treated at first, when painful, by the 
application of cold, wet cloths (water and tincture of arnica in 
equal parts. ) 

The quantity of blood escaping from the ruptured vessels 
depends, in a large degree, upon the size and number of vessels 
injured, but in a larger degree upon the space into which the 
blood can accumulate. A single divided vessel in the scalp, owing 
to looseness of the tissue there in which the vessels are distributed, 
may permit a swelling, the result of the escape of blood, 
extending in area over a half of one side of the head. 

In contusions, the first conspicuous symptom is that of shock, 
which generally, but not always, bears a relation to the extent of 
the injury. Thus a crushed finger is attended, as a rule, with 
much less shock than a crushed hand or foot. Contusions of 



16 ACCIDENTS AND EMERGENCIES. 

certain parts, as the larger joints, breasts, and other portions of 
the body, are followed by most severe symptoms of shock. The 
pain is not always as severe as might at first be supposed, as the 
nerves may be so much injured as to be deprived of their ability 
to receive and transmit the necessary impression. The swelling 
depends, at first largely upon the blood, poured out by the injured 
vessels, and as just mentioned, this depends upon the number 
and size of the divided vessels, as well as upon the character of 
the part containing them. 

Contusions of the chest or abdomen may be very serious, for 
beside the external bruises, important, internal organs may be 
injured. Evidence of this may be seen in spitting of blood or 
vomiting it, or passing it from the bowels or from the bladder, or 
there may be great depression. In such cases little can be done 
by the non-professional person beyond securing complete rest and 
sustaining the strength of the sufferer by means of warmth 
applied externally, and careful stimulation internally, as described 
in speaking of shock — to which reference has been made. 

A common accident is a " mashed finger," from the member 
getting caught in a closing window, or want of precision in using 
a hammer. The firm bone beneath and the blow above usually 
contuse (bruise) the tissues (veins, vessels, muscles, etc.) between, 
and often the pain and other symptoms last some days. 

Wrap up in a bandage of old muslin, keep constantly wet. 
with cold water. If there is mnch pain add laudanum or the 
tincture of arnica. These are not curative agents but they lessen 
the pain by benumbing the injured nerves. It is unnecessary to- 
say that a ' ' mashed toe ' ' should be treated in the same way. 

A wound is a recent solution of continuity in any soft part 
of the body, occasioned suddenly by external causes, and 
generally attended with hemorrhage (bleeding) at first. Personal 
peculiarities of the patient, and the health or disease of the 
wounded part of the body, may exert much • influence upon the 
hemorrhage. Usually it ceases in a short time by the coagulation 
(clotting) of the blood in the severed extremity of the vessel, 
without further attention than the application of cold, which favors 
contraction of the divided bloodvessels as well as those leading ta 



ACCIDENTS AND EMERGENCIES. 17 

the injured part. Should an artery or branch have been divided 
(indicated by a spurting of a spray of bright blood at each beat of 
the heart), the bleeding may not cease at once. To stop it, the 
firm pressure of the finger for some time to the point of division 
should be used, to diminish the size of the vessel at that point, 
until a clot is formed there. 

Sometimes, pressure to the supposed seat of the injured vessel 
does not reach the artery. In such a case, the pressure must 
be made to some known trunk between the original supply of the 
blood and the injured branch. Thus, if the finger or the toe is 
the seat of the arterial hemorrhage, firm pressure applied each side 
of the finger close to the hand, or toe close to the foot, compresses 
the arteries passing along to be distributed to the extremity. If 
the hand or foot is the seat of injury, pressure on the wrist, over 
the point where the artery is felt for the ' 'pulse, " or at the inside of 
the ankle, will materially retard the passage of the blood beyond 
these parts. Pressure applied by the fingers, with broken ice in a 
towel bound round the arm, in conjunction with the elevation of 
it, will often stop the hemorrhage, or retard it, until professional 
aid is secured. If the foot is the seat of the injury, elevate the 
whole limb in the same way, applying pressure and pounded ice 
on the same principle. 

In wounds of the scalp, there is usually much loss of blood, 
owing to the abundant blood supply of that part. The firm skull 
below offers a good point for the pressure, and the vessel rarely 
fails to be compressed if the thumb is applied over the point of 
division of the severed vessel. Permanent pressure may be exerted 
by means of a temporary tourniquet to the injured artery or vein 
in this way : A common folded handkerchief, with a firm, 
sharply-defined knot tied at the middle, or a long strip of muslin 
torn from a shirtsleeve, or even a suspender, with a suitable knot 
in it, is rather loosely tied around the arm, and the slack taken up 
by twisting w T ith a cane or stick until the knot, kept over the 
vessel, exerts enough pressure to prevent the passage along it of 
the blood. This is easily done if you proceed to it quietly, 
without talking ; especially if previously practiced once upon the 
extremity of a friend. Get the knot over the artery, keep the knot 



18 ACCIDENTS AND EMERGENCIES. 

there, and tighten until the pressure of the knot closes the vessel. 
Foreign matters such as have been introduced into the wound at 
the time of the injury or subsequent to it, of course, should be 
carefully removed. 

Having thus referred to certain features common to most 
wounds, the special, and what may be called the distinctive points 
of each class, according to the arrangement herein adopted, will 
now be given. 

CONTUSED WOUNDS. 

These are cuts or tears accompanied with bruising of the 
tissues. They are to be treated like lacerated wounds. Unless 
they bleed freely warm applications are better suited to such 
wounds than are cold ones. 

INCISED WOUNDS. 

Incised wounds, or clean cuts, if simple and small, call only 
for a piece of sticking plaster, and perhaps a bandage. If large, 
the edges should be brought as near together as possible, and 
supported so \yy sticking plaster, or bandages, or the hands, till 
the coming of the surgeon. If an entire part be cut off, as an 
ear, or a nose, or a toe, or a finger, it should be cleaned with 
hike- warm water, (disinfected by the addition of a few drops of 
Carbolic Acid) and put in its place, leaving to the surgeon the 
decision whether it be worth while to try to save it. Some very 
remarkable cases of re-union of such parts are on record, and an 
attempt to save them is not to be lightly rejected, especially at this 
^antiseptic day in Surges . 

Cuts of the walls of the abdomen and cuts of the chest- wall 
should be cleansed, if dirt}', with slightly carbolized warm 
water and covered with a clean white cloth soaked in carbolized 
warm water and kept warm and wet by a gentle stream of water, 
or by laying on it a sponge soaked in warm water, which should 
be constantly renewed. This is also the treatment resorted to 
(until the arrival of a surgeon) in cases where portions of the 
bowels or of the lung protrude. 

Cut throat wounds usually require, in addition to the 
ordinary treatment of the wound, that the head shall be bent 



ACCIDENTS AND EMERGENCIES. 19 

forward, with the chin close to the breast bone, and kept there. 
It ma}* be necessary to stitch these wounds. 

LACERATED WOUNDS. 

Lacerated wounds are tears with ragged edges, such as are 
often caused by machinery, bricks, clubs, timbers, stones, dull 
tools, glass, hooks, etc. These always require surgical skill. Till 
it can be obtained, however, the torn parts can be placed in as 
nearly their natural position as possible (after removing, with a 
stream of lukewarm water, carbolized, squeezed from a sponge, 
any foreign matters that can be so gotten rid of) and covered with 
a cool, wet cloth, or a cloth soaked in laudanum. 

PUNCTURED WOUNDS. 

Punctured wounds are made with sharp-pointed objects, like 
arrows, pins, needles, tacks, fish-hooks, glass, thorns or splinters. 

Of these, pin wounds rarely do much harm. If a needle is 
run into the flesh and comes out, always see that it is all there ; 
and if an}* part, from point to eye is missing, call a surgeon. 
Meanwhile keep the wounded part perfectly still, and make no 
attempt to remove what remains. The broken needle should be 
carefully kept and shown to the doctor, as he will then know 
what to look for in his examination. 

Thorns rarely do much harm unless they are poisonous, and 
wounds of this kind we shall consider later. 

Splinters under the nails sometimes defy attempts at removal 
by the non-medical. But the way to succeed is to scrape the nail 
as thin as possible over the splinter, then split it or cut a little 
tongue out and remove the splinter. 

Splinters of glass are quite beyond most people's skill. 
They are best treated with cold applications, and left otherwise 
entirely to the surgeon. 

If a large splinter enters the body, an attempt may be made 
to pull it out ; but a surgeon should be called without fail, and 
Avhatever of the splinter has been extracted, carefully saved for 
Iris inspection. 

POISONED WOUNDS. 

Poisoned wounds may be considered here, as they are usually 
^punctured, and result from the bites or stings of animals or insects. 



UO ACCIDENTS AND EMERGENCIES. 

The bites of venomous serpents usually demand the prompt, 
removal of the part bitten. It may be cut out instantly by any 
one who has the nerve to do it. Before this, perhaps, the part, 
should be encircled, above the wound, with a tight ligature, and, 
if small enough, thrust into the mouth and sucked hard so as to 
extract the poison. The immediate application to the wound of 
hartshorn is of advantage and a knitting-needle, or nail, heated 
to redness, may be thrust into it. At the same time, whiskey 
should be given, in doses large enough to cause drunkenness, and 
the intoxication kept up till medical aid can be secured. 

The stings of insects — of tarantulas, scorpions, centipedes, 
etc., are to be treated with cold, wet applications — wet. earth is a. 
very good one. The application of a drop of hartshorn or wet 
salt often gives great relief. The bites of cats and rats are some- 
times followed by severe inflammation , but the first treatment: 
should be simpfy cleansing the bites, sucking them, perhaps, and 
applying cold to them for a time. 

The bites of dogs are a terror to many people, while others- 
have little fear and are very seldom bitten. If any one be bitten 
by a dog in good health, only the simplest treatment will be 
necessary. If the dog be sick, local inflammation, or severe 
constitutional disturbance may follow. In case of reasonable 
suspicion, the same course should be adopted as for bites of 
venomous snakes. Of course, too, sound medical advice will be. 
necessary. 

GUNSHOT WOUNDS. 

This is another class of injuries, occasional ly met in civil' 
life, though not common. Ordinarily little can be done for 
them, except by a surgeon ; and perhaps all that is advisable 
before he comes is to note and remember the position of the body 
or the wounded part at the moment it was struck, and the. 
direction from which the missile came, so that these facts may 
help the surgeon in his search for it. There is rarely much 
bleeding from gunshot wounds, except when large vessels are 
divided. In such a case the bleeding may be controlled as* 
described under the head of hemorrhage. 



CHAPTER IV. 

ACCIDENTS AND EMERGENCIES. — CONTINUED. 

-Asphyxia— Its Meaning. Asphyxia from Drowning— Resuscitation. How to Determine 
whether Life is Extinct. How to Save Lives. Methods of Producing Artificial 
Respiration. Asphyxia from Strangulation by Hanging. Asphyxia from Suffocation 
with Noxious Gases and Vapors from Poisonous Mines, Wells, or Privies, from the 
Fumes of Charcoal, from Common Burning Gas and from the Gas of Bituminous 
and Anthracite Coal. Asphyxia from Narcotic Poisons— What to Do. Foreign Bodies 
iu the Eye. Ear, Throat, Windpipe and Nostrils. Sunstroke and Heat Prostration — 
Prevention and Treatment. 

Asphyxia means, literally, without pulse, or suspended 
animation. It is produced by the non-conversion of the impure 
or venous blood in the lungs into the arterial or pure blood. The 
,-supply of good air to the lungs being cut off by some cause, the 
•necessary purification at that point no longer takes place, and death 
of the entire body ensues from the absence of pure blood, or the 
presence of impure blood. 

There are several varieties of asphyxia, as : i. Asphyxia from 
submersion as in drowning ; 2. Asphyxia from mechanical causes, 
.as by strangulation, or hanging or by foreign bodies in the wind- 
pipe or its approaches. 3. Asphyxia by inhalation of gases, known 
as suffocation. 4. Asphyxia from torpor of the medulla oblongata 
<(an important portion of the brain, connecting the cord with the 
^brain) produced by insufficient respirations. 

DROWNING. 

In asphyxia from drowning if natural breathing has ceased, 
the first thing to be done is to free the body from any clothing 
that binds the neck, chest or waist, turn it over upon the face for 
a moment, thrusting a finger into the mouth and sweeping it 
around, to bring away anything that may have gotten in or 
.accumulated there. Then the body should be laid out flat on the 



22 ACCIDENTS AND EMERGENCIES. 

back, with something a few inches high under the shoulders (any- 
thing will do ; a coat, a shawl, or stick of wood), so as to cause 
the neck to be stretched out and the chin to be carried far from the 
chest. The tongue should now be drawn well forward out of the- 
mouth, and held by an assistant, or, if there be no one to do this, 
a pencil or a small stick may be thrust across the mouth on top of 
the tongue and back of the last teeth, to keep the mouth open and 
the tongue out of the throat. An effort to secure artificial 
respiration should now be begun. The simplest way to do this;, 
is for some one to place himself on his knees behind the head, seize- 
both arms near the elbows and sweep them around horizontally,, 
away from the body and over the head till they meet above it,, 
when a good, strong pull must be made upon them and kept: 
up for a few seconds. This effects an i?isph r ation — fills the lungs 
with air, by drawing the ribs up, and thus enlarging the cavity of 
the chest. The second manoeuvre consists in returning the arms 
to their former position alongside the chest, and making strong: 
pressure against the lower ribs, so as to drive the air out of the 
chest and effect an act of expiration. This need occupy but a. 
second of time. This should be kept up for a long time, and not 
abandoned until a competent person has ascertained that the heart 
has ceased to beat. The cessation of the pulse at the wrists- 
amounts to nothing as a sign of death ; and often life is present 
when only a most acute and practised ear can detect the sound of 
the heart. In a moderately thin person, deep pressure with the 
finger ends just below the lower end of the breast bone may some- 
times reveal pulsation in the aorta, the main arte^ of the bod}^ 
wmen it cannot be found anywhere else. It is important that the 
wet clothing shall be removed as soon as possible from a drownedL 
person. This can always be done without interrupting the 
artificial respiration. If exposure must be avoided, something mayr 
be laid over the body (a coat, a shawl, a blanket, or a sail, if om 
board a ship,) and the wet clothes loosened under it and drawn- 
down over the feet. Then the body ma}' be quickly slipped into- 
something dry, and covered with some other fabric, if the first- 
has become wet, while this, in its turn, is pulled away fromi 
underneath. . 



ACCIDENTS AXD EMERGENCIES. 23 

Some stimulant is to be given as soon as it can be swallowed. 
Teaspoonful doses of whiskey or brandy, in a tablespoonful of 
hot water, may be given every few minutes, till the danger point 
is passed. 

As natural respiration begins to be attempted it should be 
aided as much as possible by timing the artificial to it. It may be 
stimulated by applying smelling salts to the nose, by slapping the 
skin, or by dashing hot water upon the chest. Little by little it 
will take the place of this, but must not be left unwatched for 
sometime. 

Nothing but danger from cold or pressing necessity should 
prompt the removal from one place to another of a person who is 
being resuscitated, before this has been accomplished. After 
resuscitated the person must be put in a warm bed, being carried 
carefully with the head low, and a watch kept to see that the 
breathing does not suddenly stop. When natural breathing has 
not ceased, all the steps just described should be carried out, with 
the exception of artificial respiration. But this should be had 
recourse to upon the first evidence that natural respiration is 
failing. 

STRANGULATION. 

Strangulation, by hanging, or by anything which compresses 
the windpipe from the outside, is to be treated by re-establishing 
the respiration in the same way as for drowning. The obstruction 
is of course to be removed, and natural respiration stimulated or 
artificial respiration employed. 

Suffocation with noxious gases or vapors, (carbonic acid gas) 
calls for instant removal to the fresh air and the establishment of 
natural respiration, or of artificial till the natural is re-established, 
as described in speaking of drowning. Gases like carbonic acid, 
the fumes of charcoal, and the collection in mines, wells or privies, 
are very dangerous to life. The removal of a person from a well 
full of poisonous gas is a very difficult and delicate matter. Some 
attempt may be made to dislodge or dissipate the gas. Buckets of 
water may be dashed down, or an open umbrella lowered by the 
handle and rapidly drawn up a number of times. But these 



24 ACCIDEXTS AND EMERGENCIES. 

efforts must not consume any more time than is required to prepare 
a man who can be lowered, securely fastened to the ?'ope, so that 
he can attach another rope to the person overcome in the well. 
The rescuer must be brave, cool and strong, and those who lower 
him no less so. He ma}* be somewhat protected by wearing a 
sack over his head, or having a thick veil over his face. But 
everything will depend upon the rapidity with which he and his 
comrades can do this work. 

ASPHYXIA FROM NARCOTIC POISONS. 

For this form of asphyxia the reader is referred to the 
articles on narcotic poisons, (opium, hyoscyamus, belladonna and 
strammonium) . 

BURXIXG CHARCOAL. 

Certain gases (carbonic oxide gas) of a very poisonous 
character, are given off during the burning of charcoal, and when 
inhaled for a sufficient length of time, rapidly prove fatal. The 
person quickly drops insensible and dies of asphyxia in man}' 
respects like the person who has succumbed to carbonic acid gas, 
described under the head of ' ' Suffocation with noxious gases or 
vapors." The same treatment should be empkwed in this case. 

COMMON BURNING GAS. 

Persons retiring at night often leave the gas " turned down," 
and the flame becomes extinguished. Enough gas often escapes 
to give serious trouble to the sleeper unless the room is well 
ventilated. Persons have been known to ' ' blow it out' ' as they 
would a candle, and suffocation more or less complete has 
followed. Treat as in asphyxia from other gases already 
described. 

FOREIGN BODIES IN THE THROAT AND WEVDPIPE. 

Choking caused by something sticking in the throat, gullet or 
windpipe, demands its removal as soon as possible. It is not 
always easy to tell which of the latter passages is clogged, but 
usually there is active irritation, with coughing, when a foreign 
body lodges in the windpipe, while swallowing can be done quite 
readily. When the gullet is stopped it is usually impossible to 



ACCIDENTS AND EMERGENCIES. 25 

swallow, and there is little or no tendency to cough, no matter 
how much the breathing may be interfered with. In reference 
to the throat, it is not so hard to tell, for one can usually see or 
feel with the finger the offending body. 

If a foreign body be within the reach of two fingers, it may 
be pretty easily removed. If not, a pair of blunt-pointed scissors 
may be used like forceps. Or a hairpin may be straightened out 
and one end bent round so as to make a loop, and this used to try 
to dislodge the foreign body ; or the handle of one blade of a pair 
of scissors may be used in the same way. It has been stated that 
for foreign bodies in the throat, such as pieces of meat, etc., a 
.simple mode of relief is to blow forcibly into the ear wdiile at the 
same time the nostrils are closed by compression. Such a plan is 
:so easy of execution that it is certainty w r orth trying. 

If foreign bodies get into the windpipe they will as a rule 
soon be coughed out, or may require surgical skill for their 
removal. A moderate blow on the back with the open hand, or 
ra quick strong squeeze of the chest, sometimes aids the coughing 
act ; and inverting the body will assist in dislodging the foreign 
bod}^ if it is not too tightly w T edged in. 

When strange things like coins, marbles, slate pencils, nails 
•or small toys are swallow T ed by children (or adults) , it is a big 
mistake to give a purgative. The proper plan is to let the bowels 
alone and to give plenty of good solid food, so that the foreign 
hody may be surrounded with the waste and carried out of the 
bod}- without injuring the w r alls of the intestines. 

FOREIGN BODIES IN THE EYE, THE EAR AND NOSTRIES. 

Particles of cinder, dust, or fragments of metal, often get. 
into the eye, and cause a good deal of trouble. Sometimes they 
-are dislodged, and washed out by the extra secretion of tears 
brought about by the irritation produced by the body. Sometimes 
this process does not give relief, and it is necessary to resort to 
-some process of extraction. A popular, and often useful plan is 
to take hold of the lashes of the upper lid, separate it from the 
eyeball, so that the lashes of the lower lid will slip up in the space, 
.acting as a brush to the inner surface of the upper eyelid. This, 



20 ACCIDENTS AND EMERGENCIES. 

of course, can not remove anything, as a rule, from the eyeball. 
A better way is the usual one of holding a knitting needle over 
the upper lid, close to and just under the edge of the orbit, then, 
holding it firmly, seize the lashes of that lid by the fingers of the 
disengaged hand, and gentry turn the lid upward and backward 
over the needle, or substitute used. Movement of the eyeball by 
the sufferer, in a strong light, usually reveals the presence of the 
intruding body, so that by means of a corner of a silk or cambric 
handkerchief, it can be detached and removed. Should the 
foreign body be imbedded in the mucous membrane covering the 
eyeball or the eyelid (conjunctiva), a steady hand and a sharp 
pointed instrument will usually lift it out. A soothing application 
to the injury is as useful as the same thing applied to a wound of 
the hand. Take a spoon, heat it, and pour in a few drops of 
laudanum. It will soon become dense and jelly-like. A few 
drops of water added will dissolve this gummy material, and the 
liquid thus formed may be applied by the finger to the " inside of" 
the eye," as they say. The laudanum is opium dissolved in 
alcohol. The alcohol is somewhat irritating, but is easily 
evaporated by the gentle heat, leaving an extract of opium, which 
is dissolved in the water afterward added. 

When a fragment of lime gets in the eye, do not waste time 
by trying to pick it out, but neutralize the alkali by a few drops 
of vinegar (which is dilute acetic acid) in a little water. Even 
when this is done rapidly, the ulceration caused by the alkali will 
be some days in disappearing. In all cases where lime has entered 
the eye, even when these things have been used, no time should, 
be lost in going to a surgeon. 

The discovery of cocaine as a local anesthetic and anodyne, 
renders all operation on the eye completely painless and thus 
comparatively easy. A few drops of a 4% solution of this 
invaluable drug dropped into the eye whenever a foreign body 
lodges in it, will always remove the pain and sensibility 
immediately and the organ is not injured thereby, but can be: 
explored, and the foreign substance very readily removed. 
Cocaine thus applied is a panacea in all painful conditions of the 
eye. After the foreign body has been removed, the inflammation . 



ACCIDENTS AND EMERGENCIES. 27 

or congestion which remains can readily be reduced by the 
following eollyrium (eye water) : 

Take Boraeic Acid, 10 grains, 
White Vitriol, i grain, 
Camphor Water, 
Rose water, of each 1 2 an ounce. 

Mix and apply by drops into the eye when necessary. This 
eyewater is also excellent in all forms of inflamed eyes. 

The curious disposition of children to insert foreign bodies, 
such as grains of coffee, corn, pebbles, peas, buttons, etc., up the 
nostrils, and into the ear, is too well known to need more than a 
passing notice. But the sooner these substances are removed, the 
easier it is to do so, and likewise the better. 

If the body is soft it absorbs moisture from adjacent parts, 
and becomes swollen and more difficult to remove. If the foreign 
body is hard, the irritation and inflammation which it will surely 
set up in the contiguous parts will in a short time materially 
increase the difficulties of removal. 

If the body is up the nostrils, the child should be made to 
take a full inspiration, that is a full breath. Then closing the 
other nostril with the finger, and the mouth with the hand, the 
air of the lungs, in escaping through the nostril closed to a degree 
by the foreign body, assisted by a sharp blow from the palm of 
the hand to the back, will very often expel the substance. 

But if it will not escape in this way, and if it is seen near the 
opening of the nostril, mothers should not make the mistake 
wmich is so often made in these cases, of making compression by 
the fingers, just above the object, as that w T ill likely press it 
further up. 

Should the first measure not remove the foreign body, it may 
very readily be extracted by the surgeon with a pair of polypus 
forceps, a bent probe or an earscoop, and the child had better be 
taken to a skillful doctor. Parents could frequently do this 
extraction did they not lack the proper appliances. 

Insects, like flies, gnats, bed-bugs, etc., sometimes get into 
the ear. The best way of getting them out is to hold the head 
of the child or person with the disabled ear upwards, and fill the 



128 ACCIDENTS AND EMERGENCIES. 

cavity with sweetoil or glycerine. Lukewarm water will likewise 
answer if the other means are not at hand. It drowns the 
animal, by closing up its breathing pores, and in a short time it 
floats to the surface of the fluid used. 

Foreign bodies in the ear are more troublesome to deal with. 
No effort to remove them with a probe, or anything of the kind, 
should be made by anyone except a professional man, for fear of 
permanent injury to the ear. The head of the child, face 
downward, should be held firmly between the knees, and with 
a Davidson or bulb syringe a stream of tepid water should be 
injected into the ear. The nozzle of the syringe should not be 
introduced into the cavity, as its presence ma}- push it further 
into the ear or prevent the dropping out of the foreign body after 
the water has been forced past and beyond it. Should these 
.means not succeed, b} r all means consult a surgeon without delay. 

The tube of the ear is somewhat curved, and when 
straightened somewhat by catching hold of the upper lip, and 
gently pulling it upwards towards the crown of the head, the 
liquid flows in more readily. 

SUNSTROKE OR HEAT APOPLEXY. — ITS CAUSE. PREVENTION 
AND TREATMENT. 

Sunstroke is a condition in which the system is overwhelmed 
by excessive heat, either solar, or artificial. It is known to the 
medical fraternity under various names, such as thermic (heat) 
fever, heat apoplexy and heat prostration. 

Two distinct bodily conditions, accompanied with disorder of 
consciousness, arise during exposure to heat. They are of two 
forms, first, the hyperpyrexial form, a condition in which there is 
coma with full and slow, or rapid and jerking pulse, hot and 
flushed or dusky skin, and very high temperature (105 to no° 
Fahr. ), and second the asphyxial form, where there also is coma 
with feeble pulse, cold skin and lowered temperature. 

Far back in the earliest historical times there is mention made 
-of sunstroke, and ancient medical writers have full}- described it. 
And the affection was not unknown in biblical da^^s, as the 
following passages clearly show : In II Kings, chapter 22, verses 



ACCIDENTS AND EMERGENCIES. 29 

iS, 19, 20, appears the following: "And when the child was 
grown, it fell on a day that he went out with his father to the 
reapers. And he said unto his father, ' My head, my head.' 
And when he had taken him and brought him to his mother, he 
sat on her knees till noon, and then died." This instance relates 
to the son ol the Shunammite woman, who was restored to life 
by the prophet Elisha. 

In the eighth chapter of Judith, verses 2 and 3, we find also 
an instance in which death resulted irom what is known to us as 
sunstroke. It is as follows: "And Manasses was her husband, 
of her tribe and kindred, who died in the barley harvest. For as 
he stood overseeing them that bound sheaves in the field, the heat 
came upon his head, and he fell on his bed, and died in the city 
of Bethuliah ; and the}' buried him with his fathers. ' ' 

As has been said the immediate cause of sunstroke or heat 
fever is always exposure to heat, natural or artificial, but it must 
not be inferred that it is confined to tropical regions. Sunstroke 
is very rare in dry, hot climates and frequent in tropical lowlands, 
as well as in large steam laundries, sugar refineries, and other 
places where men work in damp, hot air. 

The reason for this is that owing to the interference with 
evaporation, and the consequent cooling of the body, heat in a 
moist atmosphere is much more dangerous than is dry heat. 
Exposure to the direct raj's of the sun is not necessary and many 
of the worst epidemics have occurred during tropical nights. 
New York and other northern cities suffer from its yearly- 
visitations. At certain seasons the number of cases, in proportion 
to the population, far exceeds that of the more tropical towns. 
In New York, especially, the mortality has been very great. 
During the summers of 1866 and 1868 an immense number of 
cases were recorded. Visitors to the tropics from the colder 
regions, who are unaccustomed to a high temperature, are 
particularly susceptible ; while the natives, who live constantly 
exposed to the heat, are comparatively safe. The sufferers in 
most cases are exposed to the heat for some days preceding the 
attack, consequently sunstrokes usually appear the third or fourth 
day from the commencement of the heated term. 



30 ACCIDENTS AND EMERGENCIES. 

It has been noticed that the majority of sunstroke cases 
(generally laboring men), occur in the morning or early 
in the day. Excessive bodily fatigue and intemperance or 
anything tending to lower the vitality of the system predisposes 
to the affection. It is on this account that persons of intemperate 
habits and debilitated systems are most liable to the attack. The 
fact that males are much more frequently affected than females 
depends simply upon the habitually greater exposure of men to heat. 

In typical cases of sunstroke the symptoms may be divided 
into premonitory and immediate. The premonitory symptoms 
are not always evident. The person complains of headache and 
a burning sensation about the head, and during the night is restless 
and wakeful. The skin is dry and uncomfortably hot, and there 
is frequent desire to empty the bladder. The face is flushed, and 
eyes congested ; the bowels are usually constipated. 

A person presenting these symptoms, who, nevertheless, 
continues to work under the hot sun, or in an overheated building 
will be suddenly seized with vertigo, intense headache, and 
dimness of vision. His limbs refuse to support him, and he 
soon falls to the ground. Insensibility sets in, the breathing 
becomes loud and snoring, the pupils contract, and the skin is 
intensely hot. The coma may be partial or complete, and 
occasionalh' there are convulsions. The bowels are somewhat 
relaxed, and vomiting is not infrequent. In those varieties of 
sunstroke characterized by exhaustion the patients are more apt 
to die suddenly without special premonitory troubles. Death 
indeed may be almost instantaneous, the victim falling as if struck 
upon the head by a blow. 

The reason why consciousness is lost from exposure to 
extreme heat is not fully understood. Some writers advance the 
theory that overheating of the blood calls for excessive action in 
the nerve centres, which rapidly exhausts their force and power. 
Others assert that the heated blood produces great depression of 
the nervous system, thus preventing it from performing its 
functions. The latter theory seems the most plausible. 

The recover}- from sunstroke is often more to be dreaded than 
death itself because sunstroke gives rise to a varied sequelae, 



ACCIDENTS AND EMERGENCIES. 31 

such as amaurosis (blindness from organic changes in the brain), 
obstinate and distressing headache, impairment of the intellect, 
and indeed insanity is no uncommon sequence. 

Now as to the treatment of sunstroke. It was considered 
imperative, at one time, to abstract blood in all cases of sunstroke, 
but modern enlightenment has driven out this therapeutical agent. 

The person attacked should at once be carried to a cool, airy 
spot, in the shadow of a wall, or to a large cool room, in a house 
with a bare floor. He should then be placed in a recumbent 
position, the clothes stripped off, and a stream of water (from a 
height of about four or five feet above the patient) be poured over 
the body, so that the patient may receive the benefit of the shock. 
The stream of water should at first be directed on the head, then 
on the chest and abdomen, and finally on the extremities, and thus 
alternating from one part to another, until consciousness returns. 

Ice rubbed over the bod)- is recommended by some, but the cold 
douche is preferable. Internal medication is useful in all cases. 
Among the numerous drugs employed, bromide of potassium has 
been found most efficient. If the person is unable to swallow, it 
can be given by injection into the rectum, always remembering 
to increase the dose by one-quarter more than when given by 
mouth. In mild cases from 5 to 10 grains may be given, at 
intervals of from half an hour to one hour, until the grave 
s^mrptoms disappear. In severe forms from 10 to 30 grains may 
be administered every half hour ; when the pulse becomes weak 
or intermittent, stimulants are needed. 

Stimulants should be resorted to in all cases where exhaustion 
is the prominent feature. Brandy and milk, or brandy with 
ammonia must be introduced into the stomach or rectum. It is 
well to remember that in the cases where the skin is cold, the 
cold douche will do no good whatever. After consciousness has 
Teturned, mustard plasters or blisters are to be applied to the back 
of the neck or behind the ears. The bromide need not be 
discontinued for one or two weeks. 

Upon recovery the brain must rest from all work ; exercise 
in the open air is essential. Freedom from excitement and regular 
.habits must be rigidly enforced. A continuance of this treatment 



32 ACCIDENTS AND EMERGENCIES. 

for several months lessens, if it does not entirely prevent, the 
danger from nervous affections which follow sunstroke. It is 
said that persons who have once suffered from sunstroke, for a 
long time after are unable to bear exposure to the heat without a 
recurrence of the symptoms of the malady. 

But it must always be remembered that sunstroke, or 
heatstroke, is a very dangerous thing, and may be followed by- 
grave and permanent impairment of the intellect. 

HEAT EXHAUSTION. 

This is a condition of great depression of the system due to 
the action of heat, and, occurring in hot weather, it might be 
confounded with sunstroke or heatstroke. But in heat exhaustion, 
instead of a hot, dry skin, there is a cold, moist one. This calls, 
for rest, fresh air, a cool apartment, but no application of cold to 
the surface. Small doses of brandy, thoroughly diluted, may be- 
given, and the system gradually brought back from its depression.. 

THE PREVENTION OF SUNSTROKE, HEATSTROKE OR 
HEAT-EXHAUSTION. 

During the heated term, as it is called, all use whatever of 
malted, fermented, or distilled drinks should be abstained from. 
Not only do they favor, in a general way, a condition of the, 
system in many respects similar to that which leads to sunstroke, 
but they deaden sensibility at the very time it ought to be on the 
alert ; and the person is less able to detect slight changes in his 
feelings, which otherwise might have served as useful warnings in. 
his behalf. The use of such substances, under the circumstances, 
seems as unwise as it would be for a person, in a time of great, 
danger, to prepare for watchfulness by taking a dose of laudanum ; 
or for a worker with his hands among hot metal to apply 
something to them by which sensibility would be deadened or 
destroyed. By night, perhaps, he would have no fingers left. 

If there is a time above all others, the year around, when 
every precaution for the preservation of health is required, it is. 
during the hot months of summer. 

Every night a bath should be taken and the drinking of large 
quantities of cold water, merely because it is cold, should be 
avoided immediately before, during, and after meals. 



CHAPTER V. 

Accidents and Emergencies. — Concluded. 

Frost-Bite— The Fingers, Toes, Nose, Ears and Lips, the Parts Most Frequently Attacked 
— Treatment. "Frozen to Death" — Its Meaning. Chilblains — Description and 
Treatment. Accidents from Lightning — Shock and Burns from It — Treatment. 
Spitting of Blood. Poison Vine Eruption — Treatment. Whitlow or Felon — 
Appearance and Treatment. Boils and Carbuncles. Earache — Treatment. Headache 
— Varieties— Nervous and Congestive, etc. Toothache and the Way to Prevent It. 
Faceache — Treatment. 

FROST-BITE. 

Exposure to cold, of severe degree, often leaves the fingers 
toes, nose, ears and lips, more or less frozen. This condition 
short of absolute death of the part, is termed frost-bite. It will 
be observed that the portions of the body just enumerated are 
those most exposed, in area, to the influence of the cold, and 
are furthest situated from the heart ; and it will perhaps be 
unnecessary to remark that persons who are debilitated are more 
apt to suffer with the same amount of exposure than the 
robust. 

When the circulation of any part begins to succumb to the 
influence of the cold, it becomes puffy, blueish, and smarting. 
This is because the blood flows more slowly than natural through 
the vessels exposed near the surface. Soon this blueness 
disappears, and the part becomes pallid, as if the influence of the 
cold had contracted the vessels to an extent incompatible with the 
passage of blood through them. The pain at this point ceases ; 
indeed until he meets a friend, he often does not know of his 
mishap. At this stage, the injury has become so great that, 
unless proper means are taken to restore circulation, complete 
4 



34 ACCIDENTS AND EMERGENCIES. 

death of the part ensues, and in due time sloughs away, and is 
detached from the line of living tissue. 

What takes place in a part of the body, known as frost-bite 
may take place in the whole of it. This latter condition is called 
" frozen to death." The blood of the extremities being gradually 
forced from them, under the continued subjection to the cold, is 
forced inward upon the larger blood-vessels, heart, lungs, and 
brain. There is increasing difficulty in breathing, owing to the 
engorged state of the chest, and what would always be 
remembered by one so exposed to cold, an unconquerable desire to 
sleep. To sleep then is to die. If the person exhibits such a 
symptom, he must, by all means, be kept constantly moving. 

TREATMENT. 

Always remember, that the frozen person is to be kept away 
from the heat. A person taken up insensible, or approaching it, 
from exposure to the cold, should be taken into a cold room, his 
clothing removed, and thoroughly rubbed with snow, or cloths 
wrung out with ice-water. The friction to every part of the bod}^, 
particularly of the extremities, must be continued for some time, 
until signs of returning animation appear. When the frozen 
limbs show signs of life, the person should be carefully dried ; 
put in a cold bed in a cold room ; artificial respiration 
used until the natural breathing is established ; then brand)^ 
given, also ginger-tea and beef-tea. Usually by this time medical 
advice will have been secured to direct further treatment. Should 
it not, do not forget that the patient is to be brought by degrees 
into rather warmer air ; and lest in some part there might still be 
defective circulation, the person should be kept away from 
.exposure to the heat of the fire. 

CHILBLAINS. 

Chilblains, as the name implies, is when the circulation of 
the part has become chilled — disturbed, not destroyed. It is 
generally attended with much itching and smarting, and is usually 
found in the toes, outside edge of the feet, just where the toe 
emerges, or in the heel. Sometimes, in persons of debilitated 



ACCIDENTS AND EMERGENCIES. 35 

state of health, the hands suffer. These symptons are particularly 
annoying just after lying down in bed, owing to the exposure 
to the heated air formed and retained between the bed clothing by 
the body. The treatment is to keep the part away from the fire, 
and even- night, before retiring, to bathe the feet in cold water, 
or rub them with snow. The}' should then be well dried with a 
soft towel. After this, the application of the ordinary compound 
rosin ointment of the apothecaries is often of use in stimulating 
the circulation through the part. The efficiency of this ointment 
for this special purpose can be increased by asking the apothecary 
to add to an ounce of it a couple of drachms of the oil of 
turpentine. It may be remarked, that persons who suffer in 
winter from cold feet are often benefited to a surprising degree by 
bathing them at night, before retiring, in cold water. Such 
persons should always keep their feet away from the fire. 

ACCIDENTS FROM LIGHTNING. 

It seems to be a fact widely known and indeed generally 
accepted, that when the human body or organism is so placed that 
it receives the direct stroke of lightning, instant death ensues ; 
and this may be laid down as the rule, but it is a rule not without 
exceptions. Cases are on record where a person struck exhibited 
no sign of life for an hour, and then recovered. Temporary 
paralysis of a portion of the body may remain for a while, as well 
as disturbance of some special function, as the sight, smell, taste 
or hearing. But under these conditions persons may be said to 
have been " struck by lightning," when in fact they have received 
only a nervous or induced electrical shock, which may be more or 
less severe, but is rarely fatal — the electrical current, in such cases, 
evidently, in its disruptive charge strikes objects in the immediate 
neighborhood of these individuals and they, on this account, 
become stunned. 

The majority of deaths from "lightning stroke" (which 
throughout the world is annually very great) occur in the level, 
open country, especially where there is a deficiency of trees. 
This accounts for the fact that in certain portions of our western 
country lightning has been so very destructive to life. 



36 ACCIDENTS AND EMERGENCIES. 

The general introduction of electricity as a motive power,, 
and its frequent use for illuminating and other purposes, makes- 
very common a class of injuries hitherto comparatively unknown, 
and it is indeed timely that the public in general, become better- 
acquainted with the source and nature of such accidents — which 
in form, as also in severity, frequently are identical with aerial 
electricity itself. The local effects of lightning to the tissues may 
result in superficial or deep burns. The bones may be fractured 
— the fractures may be compound, (the bones protruding), or 
even comminuted, (broken in small pieces), limbs or portions of 
extremities are occasionally torn entirely off. When death takes. 
place, it is from shock, cerebral effusion, or from other injuries,, 
which from their gravity, lead on to a fatal termination. 

When the person exhibits little or no sign of life, the 
clothing should be rapidly and immediately removed ; the body- 
exposed to a dashing of cold water ; then dried, placed in bed 
and artificial respiration kept up until the parts of the brain and 
nervous system in charge of this function shall have recovered 
enough to attend to it. Apply warmth to the " pit of the stomach' * 
and extremities by means of bottles filled with hot water, etc.. 
As said before, recoveries after an hour of supposed death are on 
record and efforts of revival should not be too soon abandoned. 
Some stimulant as the aromatic spirit of ammonia is proper, as. 
also brandy, either by mouth or hypodermatically administered. 
The burns of lightning or electricity are to be treated as ordinary 
burns, and the healing process is in no wise different from that in. 
burns from other sources. 

Medical literature is profuse with curious cases illustrating^ 
the peculiar freaks of lightning. The following very interesting 
and remarkable case is from Ashhurst's Surgery. "A laborer 
was standing under a willow tree when it was struck. The tree 
was partially stripped of its bark, and the man was literally taken 
out of his boots ; the latter, although greatly torn and twisted, 
were left at the foot of the tree, while the man was thrown some 
six feet away. Although he had been well clothed before the 
accident, he was, when found, quite naked ; his clothing was torn 
completely into shreds ; his watch and chain, from the effects of 



ACCIDENTS AND EMERGENCIES. 37 

lieat, were almost destroyed, his limbs presented serious burns 
and lacerated wounds ; one leg had sustained a compound 
comminuted fracture, and there was also a compound fracture 01 
the os calcis on the opposite side. The man was however, 
conscious, and finally recovered. (From the fact that the man's 
clothes were thoroughly soaked by the rain, they probably 
conducted the lightning, and thus averted a fatal result.) 

SPITTING OF BLOOD. 

This often proceeds from the back of the throat, having 
trickled down and been brought up by the movement of coughing. 
If the blood comes from the lungs it is usually of a bright red 
color and is somewhat frothy in appearance. It is suggestive of 
trouble there, but not always so in 3-oung people, especially in 
young women. The amount of blood lost is rarely in itself fatal. 
As salt is always given in such cases, it has acquired a good deal 
of popular confidence for arresting the loss of blood. Fragments 
■of ice can be given with it. 

TO CHECK VOMITING. 

If due to mere irritability of the stomach or nervous system, 
the aromatic spirits of ammonia, in twenty drop doses in ice 
"water, every few minutes, iced mineral water, iced champagne, 
thirty drop doses of brandy, ever}^ few minutes, a mustard 
plaster, cayenne pepper plaster, broken ice in a bladder to the 
stomach, or opposite, over the spine, are all useful. The last 
often succeeds where other things fail. A common tumbler with 
fragments of paper dipped in alcohol or cologne, and ignited, to 
-act as a "cup," used to the pit of the stomach, is likewise 
useful. Sometimes the vomiting is a proper effort to get 
something out of the stomach that ought not to be there. If 
this is known to be the case, assist it with a solution of salt and 
water, or pulverized ipecacuanha. 

POISON VINE ERUPTION. 

Several varieties of the rhus, popularly known as the swamp 
sumach or poison sumach, poison vine and poison oak, when 



38 ACCIDENTS AND EMERGENCIES. 

brought in contact with the skin of many persons, produce 
itching, redness, a sense of burning, tumefaction, and even 
vesication. Sometimes the swelling is so great as to disguise 
the features. Persons coming within the influence of even the 
emanations from different species of the rhus experience the same 
symptoms. The poisonous effects are usually observed shortly 
after exposure, and begin to decline within a week. 

Weak alkaline solution — say a tea spoonful of common 
baking soda to a quart of water, or even lime water, kept to the 
part by dipping pieces of linen in them, are useful in allaying the 
inflammation. Laudanum added relieves the pain. Weakened 
down lead water is also recommended. Cream from milk is 
perhaps as useful as am T thing else and is a good vehicle for the 
sugar of lead. 

WHITLOW OR ' ' FELON. ' ' 

This appears as a small painful spot, rapidly increasing in 
size. It is an inflammation between the bone and the nourishing; 
membrane surrounding it. A drop of pus forms, and gradually- 
increasing, separates this membrane from its attachment, until the 
whole or a part of the bone dies (necrosis). After opening freely , 
the little mass of dead tissue ( ' ' core " ) , acting practically like a 
thorn or other foreign body, will come away as soon as completely- 
detached ; and the wound slowly fills up. "Felon" is apt to- 
occur in the spring and toward the end of summer, when people 
are debilitated, and unless this condition is corrected, a person,, 
who has had one, may have another. Sometimes, it seems almost 
an epidemic. 

POULTICING. 

The best form of poulticing the finger is to keep a small cup 
constantly filled from a supply of hot mush, and hold the finger 
in it with the heat as great as can be borne. The contents of the 
cup, if often renewed, will do the finger more good in twelve 
hours than a day's poulticing in the usual way. At night, if the 
pain is very great, a teaspoonful of laudanum may be applied to* 
the finger. 



ACCIDENTS AND EMERGENCIES. 39 

BOILS AND CARBUNCLES. 

These occur most frequently in persons with a certain form of 
impoverished blood, for which attention is often necessary. This 
does not mean a dose of " salts " as a " physic." The little boils 
threatening the face and neck, if taken in time, can often be 
discouraged by frequently touching the pimple with turpentine or 
with hartshorn liniment. If the}' proceed to the step further, the 
death of the little fragment of tissue, afterward discharged when 
detached as a " core ;" poulticing to favor this, must be resorted to. 
Laudanum added often mitigates the severe pain. 

A carbuncle is a much larger boil, and there is so much 
exhaustion from the discharges, loss of sleep from pain, etc., that 
the patient sometimes succumbs during the effort of nature to 
afford relief and demands good and proper constitutional treatment. 
It is hardly necessary to say that a physician should be called in 
service. 

EARACHE. 

Earache should always suggest an examination of the teeth, 
and if one be found decayed, it must be extracted or at least 
cleaned out and packed with cotton and oil of cloves. For, many 
earaches depend upon diseased teeth. Steaming the ear will often 
give relief in earache. Place the larger end or base of a cone of 
paper over the spout of the teakettle having the boiling water, 
and the apex of the cone as near the ear as possible, not to burn 
the patient, the patient lying with the affected ear downward with 
it sufficiently free to allow the steam to enter the canal. To be 
used from three to five minutes at a sitting, and as frequent as 
necessary. 

A folded cloth wrung out of hot water, with a teaspoonful 
of laudanum poured over it, or a big, hot poultice — for which 
hops is the best material — should be applied to the side of the 
head and kept as hot as possible. Hot drinks should be given 
also, and enough laudanum to cause relief from pain. The 
occurrence of an earache should always lead to consulting a 
doctor, for it is often of importance as a sign of disease which 
may seriously affect the hearing. The writer has had great 



40 ACCIDENTS AND EMERGENCIES 

success in relieving earache with cocaine in solution dropped into 
the ear, as well as with sulphate of atropia mixed with oil of 
sweet almonds poured into it. 

headache. 

By headache is meant any pain in the head independent of 
location or cause. It is always S3 r mptomatic of some local or 
constitutional disorder. It is comparatively an easy matter to 
relieve a headache temporarily, but this is not accomplishing 
permanent results. 

The causes are various, astigmatism, myobia, presbyobia, 
improper light and print, eye-strain and weakness of the eye 
muscles cause most of the cases met with in those who do much 
close work with their eyes. Excitement, worry, grief or prolonged 
mental activity will cause it, as will also, by reflex action, uterine 
diseases, indigestion, improper food, constipation and pathological 
secretion of bile. Uremia, syphilis, cancer, and the menstrual 
period are frequent causes, in fact, it is the ever present symptom 
in almost all diseases. 



VARIETIES. 

Hemicrania or migraine, is an affection located on one side of 
the head only. Vomiting, throbbing pain in the temple and 
forehead, and occasionally rise in temperature are present. It is 
paroxysmal in character, each attack lasting one or more 
hours. 

Nervous headache is most common in enaemic women ; short 
in duration and very severe. No increase in temperature, but 
great nervousness and after-prostration. 

Congestive headache causes throbbing pain through the 
temples ; congestion of the veins of the face and retina, soreness 
of the eyes, and giddiness. 

Headache from eye-sXx&m is usually in the frontal region and 
is accompanied \>y eye symptoms, such as pain, photophobia, 
smarting of eyes and imperfect vision. 



ACCIDENTS AND EMERGENCIES. 41 

TOOTHACHE. 
Toothache, depending upon a cavity in a decayed tooth, is 
usually very easy to stop. To do this a fine crochet needle should 
have a very small bit of clean cotton twisted round its point, and 
with this the hole in the tooth should be thoroughly swabbed out. 
Then the point of the crochet needle should be cleaned and 
another little ball of cotton, like a very small shot, be dipped in 
oil of cloves and caught up with the end of the needle. This 
rarely fails to cure such a toothache. On the subject of the teeth 
it is well to give a few plain directions on the way in which to 
keep the teeth in good order, also on the all-important subject of 
tooth powders. 

CARE OF THE TEETH. 

The necessity of keeping the teeth clean, with a view to the 
prevention of future trouble, is overlooked by too many, even in 
the higher classes, sometimes from carelessness, sometimes from 
ignorance. Now, cannot the medical attendant do a great deal to 
combat this state of things ? The dental surgeon is often asked, 
' ' How soon should the first tooth-brush be used ?" "As soon as 
there are teeth to use it upon," should be the reply. An ideal 
tooth powder should be alkaline, since acids dissolve the tooth 
substance ; finely pulverized, that it may not mechanically abrade ; 
antiseptic, to prevent decomposition of food lodged between the 
teeth, and perhaps to destroy the microbes which are always 
choking the tubules of carious dentine ; it should contain nothing 
irritating to the gums ; and, lastly, it should be pleasant to the 
taste, or it will not be used. Fluid dentifrices do not, as a rule, 
•clean the teeth effectually unless they contain some ingredient 
which acts upon the enamel itself ; and those preparations which 
are eulogized as making the teeth white or preventing the deposit 
of tartar, should be avoided. Charcoal was at one time a very 
popular form of dentifrice, and is even now largely used, but from 
the amount of silica it contains it will rapidly wear away teeth 
that are not of exceptional hardness ; and, moreover, the gums 
in some instances become tatooed in a curious manner from the 
absorption of minute particles. Pumice powder, again, is too 



42 ACCIDENTS AND EMERGENCIES. 

gritty ; and camphorated chalk is said to make the gums spongy. 
Precipitated chalk forms the best basis for a tooth powder, to the 
base of which may be added pulv. saponis and ol. eucal}-pt., a 
drachm of each ; and, if there is no objection to the taste, half a 
drachm of carbolic acid. 

FACE ACHE. 

Usualfy is neuralgic, and heat applied is always grateful. A 
small hop pillow heated and held to the face is useful ; or the face 
may be bathed with laudanum, tincture of ammonia ; or an}- such 
substance. Mustard plasters should not be used as they leave a 
conspicuous mark, and often blister. Ordinary ca} T enne pepper, 
mixed into a stiff paste, with an equal bulk of Indian meal and 
honey, is quite as active, as useful, and does not blister ther 
skin. 



CHAPTER VI. 
Poisons and Their Antidotes. 

What Constitutes a Poison ? Mode of Action of the Different Poisons — Acid, Alkaline,. 
Mineral and Vegetable Poisons — Corrosive and Non-Corrosive Poisons. General 
Instructions, Emetics with Chemical and Physiological Antidotes — The Sheet Anchors. 
Acetic, Citric. Muriatic, Nitric, Oxalic, Sulphuric, Tartaric, Carbolic and Hydrocyanic 
(Prussic) Acids. Caustic Soda, Caustic Potash (Common Lye), Lime and Lunar 
Caustic. Tincture of Iodine. Alcohol. Arsenic. " Rough on Rats." Lead. Mercury. 
Antimony. Ammonia or Hartshorn. Nitrate of Potassa (Saltpetre). Copper. 
Phosphorus and Sulphate of Zinc. 

POISONS AND THEIR ANTIDOTES. 

A poison is any agent introduced into the system, capable of 
destrcwing life, or of producing a morbid, noxious or dangerous 
effect. There is not a single poison in the entire list, which, in 
proper quantities, and under favorable circumstances, may not be 
used with advantage to the human body ; and, on the other hand, 
there is scarcely a single thing in ordinary use, which if indulged 
in beyond the requirements of the body, or its ability to properly 
dispose of it, may not be followed by symptoms of derangement 
of the econonry ; and, in the above qualified sense, is not 
miscalled, if termed a poison. 

Immediately upon the discovery or suspicion of poisoning 
some one should be dispatched for a doctor, if possible, carrying 
information as to the poison taken, so that valuable time may be 
saved. 

Meanwhile there is much that can be done. In the majority 
of cases, the poison is introduced into the stomach. As soon as 
swallowed, a portion of the agent may commence destructive 
action upon the mouth, throat, or stomach, through the mucous 
membrane, without injuring it, into the blood, and are carried by 
it to the brain and other portions of the nervous system, where 
the really injurious action begins, by overpowering them ; so that 



44 POISONS AND THEIR ANTIDOTES. 

the breathing and action of the heart are not kept up. To this 
class of poisons belong alcohol, aconite, belladonna, stramonium, 
opium, strychnia, etc. A slight knowledge of the mode of 
action of a substance will, therefore, of itself suggest an 
antidote or remedy. If an alkali has been taken, an acid will 
neutralize it, converting it into a compound less hurtful or 
inactive. The new compound is, perhaps, injurious, but not so 
active, and can be removed from the stomach at leisure. On the 
other hand, if an acid has been taken, an alkali would naturally 
suggest itself as an antidote. 

Some substances can not be neutralized by any convenient 
article, the poison is then to be removed from its lodging place as 
soon as possible, and its effects counteracted. It should be 
remembered that the substance swallowed as a poison must be 
considered as three parts : i. The portion of that taken which 
has already had an opportunity of acting upon the mucous 
membrane (lining) of the throat and stomach, if the poison acts 
in that way ; 2 . The portion which has already passed from the 
stomach to the blood, if the poison acts in the other way ; 3. The 
portion of the poison in the stomach yet to be disposed of. It is 
the latter portion, perhaps, in most instances, we are called upon 
to first deal with ; and the means employed is, to evacuate the 
stomach with the least possible loss of time. This is done by 
means of the stomach pump or by an emetic. 

A handful of salt and a tumbler of water can always be had ; 
and anybody can mix a heaping teaspoonful of ground mustard 
with a cup of water, and get a person to swallow it. Hither, 
swallowed, will empty the stomach. A stomach pump is not 
alwa3^s at hand, indeed, very rarely can it be obtained, and it is a 
fact, that not a single non-professional person of the writer's 
acquaintance, could use a stomach pump with success even if he 
had a dozen of them at his command. 

In cases where an unknown poison, or supposed poison is 
taken. Treat as follows : 

If the patient should vomit, this should be encouraged ; if 
not, it must be provoked. The simplest wa} T to do this is to give 
large draughts of lukewarm water, and thrust a finger down the 



POISONS AND THEIR ANTIDOTES. 45- 

throat. What has been said with regard to salt and water, 
mustard and water to produce vomiting holds good here. It is to 
be remembered that there is no occasion for fastidiousness. Any 
water will do, water in which hands, or dishes, for that matter, 
have been washed, ma}', by its very repulsiveness, act more 
quickly than anything else ; and if soap has been usd, it will be 
all the better for that, as soap is an antidote for acid poisons. 
The quantity used must be large, the sufferer must be urged 
to drink and drink, a pint at a time, until he can contain no 
more, and has been made to vomit over and over again. 

After copious vomiting, soothing liquids should be given — 
oil, milk, beaten up raw eggs — all in moderately large quantities. 
These are especially valuable when the poison has been of an 
irritating character. 

If the sufferer be much depressed in body or mind the hands 
and feet cold, the lips blue, the face pale, a cold perspiration upon 
the forehead and about the mouth, then some stimulant should be 
administered. Strong, hot tea, without milk, is the best, because 
it is a chemical antidote to many poisons. Strong coffee is next 
in value. To either of these can be added brandy, whiskey, 
wine, or alcohol, in tablespoonful doses for an adult, and half as 
much for a child ; or the spirits may be mixed with a little hot 
water. Warm coverings are not to be forgotten ; and if the 
depression be great, hot water cans or hot bricks, wrapped in one 
or two thicknesses of blanket, should be laid by the side of the- 
chest, or a hugh poultice placed round the body or a blanket, 
wrung out of hot water and covered with a dry one. The author 
has taken upon himself, to describe the history, medical uses and 
properties of some of the chief poisons, feeling satisfied that the 
same will prove unusually interesting and instructive to all. 

The common acids, acetic, citric, muriatic, nitric (aqua 
fortis), oxalic, sulphuric (oil of vitriol), and tartaric, are all 
highly corrosive in their action, unless largely diluted, and act 
with even greater rapidity when taken internally than when 
applied externally. They are about as troublesome in this respect 
as concentrated alkalis, like lime, soda, potash, etc. When taken 
the acid should be neutralized, as far as possible, by giving some 



46 POISONS AND THEIR ANTIDOTES. 

harmless alkali. Limewater is usually about as convenient as 
anything else for the purpose. Common soap, from the alkali it 
contains, might be given. For nitric and oxalic acids, the 
carbonate of magnesia or lime is given ; for sulphuric acid, strong 
soap suds ; for oxalic acid, give lime water. Bicarbonate of soda 
(the ordinary baking powder) and chalk are always excellent 
antidotes in poisoning from acids. 

OXALIC ACID. 

This substance is largely used in the arts, and in private 
households, for removing stains of iron from texture and surfaces, 
wdiich it does by combining with an otherwise insoluble salt of 
iron, easily removable by water. From the strong resemblance 
oxalic acid bears to epsom salts, it has often been taken instead of 
the wellknown purgative of that name. To avoid the possibility 
of such an accident, oxalic acid should be kept in another part of 
the house from where medicines are kept, and no precaution 
omitted, by label, and other marking of the parcel, to make the 
difference between them as decided as possible. It is well to 
remember, also, that, wholly unlike epsom salts, the taste of 
oxalic acid, applied to the tip of the tongue, is quite sour. When 
swallowed the activity of this poison admits of no delay. It 
belongs to the class of irritant poisons spoken of so often, and 
produces death, it is said, by destructive action on the mucous 
membrane (lining) of the throat, stomach, and bowels. Time can 
scarcely be lost to give an emetic, but something must be given 
to rapidly combine with it, and divert its activity from the parts 
mentioned. It has a strong affinity for lime, forming with it a 
comparatively insoluble oxalate of lime ; and for magnesia, 
forming with it an insoluble oxalate of magnesia, which can be 
dislodged with less haste. A teaspoon ful of lime from a whitewash 
bucket or at the bottom of the bottle of lime water, mixed with 
a cup of water, might be given every few minutes, or some 
magnesia, may be given. All these things can easily-be had, and 
not a moment need be lost in getting the person to swallow them. 
The common "whiting," used for polishing glass, making cheap 
paint and putty, is essentially the same as prepared chalk. Scraping 



POISONS AND THEIR ANTIDOTES. 47 

the ceiling or wall will not get an antidote if plaster of paris has 
been used instead of common lime, as is often the case. The 
often recommended mantel images of plaster of paris are likewise 
of little use. Lime in the sulphate (plaster of paris) is too firmly 
united to the sulphuric acid to give it up for oxalic. After oxalic 
acid is supposed to be neutralized, an emetic of ground mustard 
or pulverized ipecacuanha may be given. 

CARBOLIC ACID. 

Carbolic acid, (or carbolsaure in German), is a product, 
derived from coal tar oil, by the process of distillation. It was 
first discovered in i860. It resembles creosote in color and taste, 
but differs from the same, in-as-much as it is derived from coal 
tar, creosote being a product of wood tar, but likewise obtained 
by the same process, that is, distillation. The best and purest 
creosote is derived from beechwood and was discovered prior to 
carbolic acid and is much more expensive. Carbolic acid as kept 
in our drug stores occurs in solid mass or hard crystals. It has 
an acrid, burning, sweetish taste, (this latter taste, perhaps, 
accounts for the fact that children so frequently drink it and are 
thus poisoned by it), and if pure, is of a perfectly white color, 
but, if even slightly impure, it has a reddish color, or will acquire 
it upon exposure, and readily assumes a liquid state on the 
addition of some glycerine, and is in this way liquefied by 
druggists before selling it to the laity. It is a remedy of very 
great value in medicine, and is administered internally in very 
small doses, in a great many complaints, but it is not the writer's 
intention to dwell upon those merits in this connection. Being 
one of the best disinfectant agents known, its great usefulness 
for these purposes, now quite well understood by the public 
in general, and is now so frequently kept as a domestic 
remedy, and so often taken by mistake and great sickness 
occasioned, or death produced through it, that it is timely that 
more should be understood of this poison and the methods known 
how to treat accidental poisoning when the same is thus taken. 

Directions for poisoning by this agent : Never administer any 
oils or fat, as they dissolve the acid and thus assist in its absorption 



48 POISONS AND THEIR ANTIDOTES. 

into the blood, which the object should be, by all means to> 
prevent. Chalk, lime water or magnesia should be given 
immediately ; plaster off the wall in emergency, also baking- 
powder, solution of carbonate of soda, emolient drinks. Promote 
vomiting, secure rest, and stimulate if necessary. If large doses> 
are taken the sensibility of the stomach becomes destroyed and. 
emetics generally fail to act, and on the whole, the alkalies or 
antacids, like chalk, lime, baking soda and magnesia become the 
chief antidotes. These should be immediately administered. 
Chalk and lime water are valuable antidotes in many poisons, and 
should be kept in all families. 

LUNAR CAUSTIC. 

The nitrate of silver, or lunar caustic is sometimes swallowed. 
The antidote of this is a very strong brine of salt and water, given 
again and again ; and vomiting should be provoked, until the 
vomited matters cease to have a look like thin milk. 

IODINE. 

Iodine, in the form of a tincture, is also sometimes swallowed 
by mistake. The antidote for this is starch and water. 

INTOXICATION AND ALCOHOLIC POISONING. 

Alcohol itself, or in the form of brandy, gin, rum, or whiskey,, 
is sometimes taken in such large quantities as to be poisonous. 
When this is the case there are evidences of deep stupor or 
depression, sometimes closely resembling apoplexy, and should be 
treated in the same way until its identity can be safely established. 
For this the odor of tne breath is a useful guide, though it may- 
be due to a stimulant, given by a bystander after an accident, 
or taken just before one. In addition, it may be remembered 
that, in a case of deep drunkennesss there is no paralysis, though 
there is helplessness equally on both sides ; that the person can be 
aroused from the stupor, and that generally if the eyeball be 
touched he will attempt to close the eyelids. In such a case an 
emetic should be given, and, if any hartshorn or aromatic spirits 
of ammonia is at hand, a teaspoonful of this in a teacupful of 



POISONS AND THEIR ANTIDOTES. 49 

water. A large draught of vinegar will often go a great way 
toward sobering an intoxicated person. If there is much evidence 
of prostration, with cold clammy skin, heat will have to be 
applied to the body, to prevent collapse. 

Emetics are sometimes of value in cases of profound alcoholic 
stupor, but it must be borne in mind that, if a mistake be made 
as has been — and the trouble be an apoplex} T , no more dangerous 
thing could be done than to give an emetic. 

[Note. — It is said to be possible to restore one who is 
helplessly intoxicated, to the almost complete use of his faculties, 
in a very short time, by administering to him a half teaspoonful 
of ammonium chloride in a tumbler of water.] 

arsenic. 

Poisoning from arsenic is either from the substance itself, 
which comes as a white sweetish powder, often used to destroy 
domestic pests, such as rats and roaches ; from paris green, 
which is the arsenite of copper, a paint, frequently used, and now 
so largely employed by farmers to destroy potato bugs and other 
insects, or by taking "Rough on Rats," which is also arsenic 
in another form. Man}' "fly poisons" contain it likewise. 
Arsenic acts as an irritant to the stomach and bowels, in many 
respects like antimony and its preparations. As soon as it becomes 
known that arsenic or any of its preparations has been swallowed 
in poisonous doses, the poison taken should be dislodged from the 
stomach, as far as possible, by vomiting (see " Emetics,") assisted 
by the finger to the throat, or the feather part of a quill. Eree 
drinking of milk, plenty of white of egg and water, or flour and 
water, should be encouraged. Not only do these things encourage 
vomiting and tend to dilute the poisons, but they offer something 
upon which the poison can expend its energy, to that extent 
saving the living tissue, and at the same time they tend to envelop 
the particles of the poison until the mass can be removed from the 
stomach. 

The antidote to arsenic is the freshly prepared hydrated 
peroxide of iron. This can be had of any apothecary in a few 
moments of time. It is quite harmless in character, and may be 

5 



50 POISONS AND THEIR ANTIDOTES. 

given in almost an}' quantity. The iron, in this particular form 
combines with the arsenic, forming a temporarily harmless 
preparation. This newly formed compound should not be 
permitted to remain and be digested, but must be dislodged 
afterward by an emetic, which the bulk of the antidote favors. 

[Note. — Another oxide of iron, closely allied to, and said to 
be a useful substitute for the hydrate peroxide, can be made by 
almost an}' one in a few moments, if some aqua ammonia, and 
some of the common muriated tincture of iron can be had. Both 
of these articles can be found in many houses, and if not there, 
in every apothecary-shop, or the office of every country practitioner. 

Take a glass tumbler, or a graduated measure, pour in three 
or four tablespoonfuls (quantity not of much importance) of 
aqua ammonia, and then a tablespoonful or more of the muriated 
tincture of iron. 

A thick, dark, reddish precipitate, like brick dust, is at once 
seen in the mixed liquids which may be increased in quantity by 
gently stirring with a broom-splint. 

This precipitate is the oxide sought, and must be separated 
from the liquid by spreading a fine handkerchief or closely woven 
piece of muslin over a cup and pouring on the mixture. The 
liquid will run through, leaving the desired oxide of iron as a 
reddish-brown, jelly-like powder. To free it from an excess of 
either substance used in its formation, a half pint or so of tepid 
water should be poured on in a gentle stream to wash the 
precipitate. The washed precipitate is now ready for use. 

A teaspoonful of this powder ma}' be given every few 
minutes.] 

Calcined magnesia and pulverized charcoal have also been 
.recommended as antidotes in poisoning by arsenic. 

LEAD. 

The form which poisoning by this substance usually takes 

■place is the acetate of lead (sugar of lead). The carbonate 

of lead, the ' ' white lead ' ' of the painters, and the red oxide 

(" red lead") are also sometimes swallowed in poisonous doses. 

They all act as irrita?it poisons. The treatment of such cases con- 



POISONS AND THEIR ANTIDOTES. 51 

sists in giving as an antidote, water acidulated to about the 
strength of lemonade, with sulphuric acid ("oil of vitriol"). 
The iodide of potash is also an excellent antidote in poisoning 
from lead. Sulphate of magnesia (epsom salts), or the sulphate 
of soda (Glauber's salt), in water, are also reputed antidotes. 

When lead is taken for some time, in any of its soluble forms, 
in small doses, as when water has been kept in leaden vessels 
" glazed " with lead, or the use of wines " sweetened " with the 
same metal, a peculiar train of symptoms, often with paralysis 
and "wrist-drop" slowly follows, known as "lead poisoning," 
or ' 'painters' colic. ' ' All such possible sources of the introduction 
of lead into the system should be carefully avoided ; and as soon 
as the effects of the absorption begin to be suspected, no time 
should be lost in consulting a physician. 

MERCURY. 

The bichloride of mercury (corrosive sublimate), often used 
as a solution in the house for destroying vermin about beds, is one of 
the most active poisons, when taken internally. The red oxide 
of mercury (red precipitate) is another dangerous salt of the same 
metal. When swallowed, the white of eggs should at once be 
given, and often repeated. In the absence of this form of albumen, 
common milk can be used, or wheat flour beaten up with water. 
These salts of mercury not only irritate the stomach, but so 
rapidly inflame and destroy it that some writers discourage the 
use of emetics. If one can be given, however, before the poison 
has had time to produce these extreme results, there can be no 
objection to its use. The continued administration of the 
mentioned antidotes is soon followed, as a rule by free vomiting. 
There appears to be little excuse for keeping such poisons about 
the house as corrosive sublimate or red precipitate. They are 
merel}^ poor substitutes for good housekeeping with some people. 

ANTIMONY. 

This metal is rarely accessible in its purity. One of its salts, 
^as tartar emetic, or the wine of antimony, (which is tartar emetic 
dissolved in wine) , is the usual source of the poison. Vomiting 



52 POISONS AND THEIR ANTIDOTES. 

is one of the most distressing and prominent symptoms of 
poisoning by this substance. Assisted with copious draughts of 
tepid water, sugar and water, flaxseed water, much of the poison 
in the stomach ma}' be gotten out. Another symptom is great 
prostration. If a small quantity only is known to have been 
swallowed, a teaspoonful of paregoric in a little sweetened water 
ma}' be divided into three portions, one of them being given every 
ten or fifteen minutes. It soothes the irritated and excited 
stomach. 

The antidote usually recommended is nut-galls, or oak-bark 
in powder. Half a dozen of the former, finely powdered, may 
be given mixed with water. The active principle in each of these 
is called tannin, now to be had of every drugstore and d}-ehouse. 
Ten grains of it (a teaspoonful — it is very light) in water will be 
equivalent to the nut-galls mentioned. A strong infusion of 
common green tea contains enough tannin to make it useful as an 
antidote. An insoluble, and perhaps inert, tannate of antimony 
is formed. 

AMMONIA. 

The ordinary aqua ammonia, sometimes known as "harts- 
horn," acts on the mucous membrane of the stomach, as would 
naturally be expected after knowing its effect upon the mucous 
membrane of the nostrils. When swallowed, it acts as a rapid 
corrosive poison. Owing to its pungency, it can scarcely be given 
by mistake in a state of purity. With olive oil, it forms the 
common "hartshorn liniments," and has thus been given 
internally. A violently acting corrosive substance, like ammonia, 
leaves no time for emetics. It is an alkali, and the common dilute 
acid known as vinegar will neutralize it. Lemon juice also would 
answer the purpose. 

Lime, also a concentrated alkali, if accidentally administered, 
acts like ammonia. 

Potash, the caustic potash, in the form of common lye, when 
swallowed, acts as the above mentioned alkalies. 

Nitrate of Potash (saltpeter), in large doses, say half an 
ounce or more, taken internally, is followed by poisonous 



POISONS AND THEIR ANTIDOTES. 53 

symptoms. There is pain, with heat in the stomach, vomiting 
and purging of blood, great prostration, and other symptoms, 
denoting the action of an irritant poison. No antidote is known. 
The treatment consists in rapidly evacuating the contents of the 
stomach by an emetic, and the free administration of mucilaginous 
drinks, with some paregoric every little while, to allay the pain 
and irritation of the inflamed parts. 

Soda. — The same things are to be said about this alkali as 
about potash, ammonia and lime. 

COPPER. 

The most common form of poison from this cause is through 
careless use of utensils made from it. Most acids form soluble 
salts with copper ; hence acids should never be used for cooking 
purposes in copper vessels. Many of the ordinan^ vegetables and 
fruits contain enough to form poisonous salts with this metal. 
Even sugar, from the ease with which solutions of it are changed 
into acids, should be cautiously used in contact with copper. 
"When copper is mentioned, it must be understood to apply to 
brass and other alloys into which copper enters as a necessary 
component. Indeed, there is scarcely an excuse for the use of 
•copper or brass as vessels any longer, owing to the superior 
advantages of similar vessels of iron lined with porcelain, 
popularly known as ' ' enameled ' ' or agate ware. The stomach 
must at once be emptied hx an emetic, and copious draughts of 
milk, or the white of eggs mixed with water. Carbonate of soda 
(the ordinary baking soda of the kitchen may answer) is said to 
oe an antidote. As much as will lie heaped upon an ordinary 
nickle cent can be given every five minutes, in water, or in the 
other named liquids. Iron filings, or the ferro-cyanide of 
potassium (Prussian blue), in teaspoonful doses every three 
minutes, may be given. 

PHOSPHORUS. 

This is not often taken in a state of purity, perhaps. It is 
the active ingredient of most of the popular ' ' exterminators ' ' for 
rats and other vermin. Children have been known to eat it with 



54 POISONS AND THEIR ANTIDOTES. 

fatal results. The}' have also eaten the ends of common matches 
with similar consequences. Phosphorus acts as an irritant poison, 
inflaming the mucous membrane with which it comes in contact. 
There is a chemical antidote, sulphate of copper. Some calcined 
magnesia may be given, in plenty of water, to be rapidly followed, 
by an emetic, and then an abundance of mucilaginous drinks.. 

ZINC. 

The sulphate of zinc (white vitriol) may be termed poisonous 
in very large doses, were it not for the fact, constantly turned to- 
good use, that it at once causes vomiting, and is brought up 
before damage can be done. Hence it is regarded as one of our 
most valuable emetics. 



CHAPTER VII. 
Poisons and their Antidotes. — Concluded, 

Vegetable Poisons. Narcotics. Stramonium. Opium and its Alkaloids. Belladonna 
Hyoscyamus or Henbane. Strychnine. Nux Vomica. Digitalis. Aconite. Lobelia 
(Indian Tobacco). Tobacco or Nicotine Poisoning. Saviue. Poisoning by Eating 
Poisonous Meats, Fish, Oysters and Poisonous Mushrooms and Toadstools. A Complete 
Table of Poisons and Their Antidotes Appended. 

The vegetable poisons are so often taken in consequence of 
mistakes in the use of medicine, that it is a wise precaution that a 
poisonous drug should alwa}~s be contained in a bottle of peculiar 
shape, or with something peculiar attached to its neck, and that 
there should also be a special place in each house where dangerous 
remedies, and such as are intended only for external use should be 
kept. For the sake of general information, the writer herewith 
describes the history, origin and uses of the narcotics and medicines 
which are so largely used by the profession at large and in fact 
constitute a class of indispensible remedies in the practice of 
medicine which no physician dares to discard from his list. But 
the same are sometimes administered in poisonous or over doses, 
by ignorance, mistake or intentionally and a person cannot possibly 
know too much about these valuable, yet potent drugs. The 
knowledge of the action, dose, and application in the treatment of 
disease, as well as their poisonous character and how to combat 
their ill effects, should certainly be very interesting reading to the 
most fastidious. 

STRAMONIUM OR HEXAKIMMEE. 

Stramonium, usually known as ' ' thorn apple, ' ' ' 'Jamestown ' ' 
or " Jimson Weed," and vulgarly called " Hexakimmel," is an 



56 POISONS AND THEIR ANTIDOTES. 

annual native plant which abounds in Europe and the United 
States, growing luxuriantly wherever the soil is fertile, but 
especially near the habitations of men. It is very often seen 
around our banwards and pig pens, and children often gather the 
seeds and eat them. It derives the name "Jamestown Weed," 
from the circumstance that a party of English soldiers, during 
the Revolutionary War, while encamped at Jamestown, Va., were 
poisoned by the leaves of the plant which the}' boiled and ate as 
greens and drank as tea. It has a forked, branching stem, from 
three to six feet high, ovate, toothed leaves of an elongated 
triangular form ; they are of a dark green color above, but paler 
below. The flower is large and funnel shaped, of white or blue 
purplish color, which appear in midsummer and is succeeded by 
a green capsule of the size and form of an English walnut, 
covered with prickles and containing numerous dark kidney- 
shaped seeds of a brownish black color. The plant very much 
resembles the castor oil plant. The whole plant exhales a rank 
narcotic odor. 

From its common occurrence in every part of the country, 
cases of poisoning from this weed are very frequent, and as has 
been said particularly with children, who are fond of swallowing 
the seeds. 

The mental excitement and disorder occasioned by an 
overdose of stramonium ma}' be very aptly illustrated by the case 
of the soldiers at Jamestown which was alluded to above. 
Beverley, in his "History of Virginia," informs us that "some 
of them ate plentifully of the plant, the effect of which was a 
very pleasant comedy, for they turned natural fools upon it for 
several days. One would blow up a feather in the air, another 
would dart straws at it with much fury, and another, stark naked, 
was sitting up in a corner like a monkey, grinning and making 
mouths at them ; a fourth would fondly kiss and paw his 
companions, and sneer in their faces with a countenance more 
antic than in any Dutch droll. In this frantic condition they 
were confined, lest they should in their folly destroy themselves ; 
though it was observed that all their actions were full of innocence 
and s:ood nature. * * * After eleven days thev returned to 



POISONS AND THEIR ANTIDOTES. OV 

themselves again not remembering anything that had passed.' 1 
In other eases the patient seems plunged in a reverie which is 
interrupted by sudden shrieks or by convulsions ; and in others 
still, the delirium is so furious as to call for forcible restraint. 
Meanwhile the head is hot, the pupils largely dilated, objects are 
seen as through a mist and often appearing double, the face 
bloated and red, and the hands and feet cold and tremulous. 

These peculiar qualities of this weed have rendered it a 
convenient agent for the speculations of knavery, for there is 
reason to believe that much of the phantasmagoria of sorcery was 
derived from this source, and that the oblivious intoxication of 
stramonium has been employed to facilitate and conceal the 
perpetration of crime. The latter is attributed to the Hindoos, 
but seems to have Christian imitators. For, as the French 
medical writers, Trousseau and Pidoux relate, a band of thieves 
was brought to trial whose plan of procedure was this : They 
mixed the powder of stramonium seeds with snuff, and, in places 
of public resort, were very assiduous in offering the snuff box to 
such of their neighbors as they wished to rob. As soon as the 
victims began to be confused and talk at random, they were 
pillaged without difficulty. 

The weed has, however, many excellent medicinal uses. It 
is prescribed internally in neuralgia, whooping cough, mania, 
epilepsy, &c, and in spasmodic asthma, cigarettes of the leaves 
are smoked with great relief. The practice, is however, dangerous 
in aged or apoplectic persons. 

Stramonium is also used by oculists to dilate the pupils and 
diminish the sensibility of the retina to light ; and it is an 
excellent anodyne (pain- allaying) application, in the form of 
cataplasm (poultice) and ointment, to inflammatory swellings, 
irritable ulcers, bed sores, and hemorrhoids (piles). 

In cases of poisoning by stramonium, the poison must be 
evacuated at once by the use of the stomach pump or by an 
emetic. Unless distinct symptoms follow, no further treatment 
may be necessary ; if, however, marked dilatation of the pupil, 
liallucination and active delirium are produced, the physiological 
-antagonist, opium, becames necessary. Tinct. of opium should 



58 POISONS AND THEIR ANTIDOTES. 

be administered until some contraction of the pupil, lessening 
of the pulse rate and cessation of the delirium occur. If 
then normal sleep comes on, the pulse, heart and lungs, 
functionating naturally, no further interference will be necessary. 
In cases of poisoning, in children especially, it is particularly- 
desirable to employ the opium with the greatest caution, since- 
children are very susceptible to this drug, and opium narcosis may 
readily be substituted for stramonium poisoning. When there is 
a certainty that this poison has been introduced into the system 
the writer would urgently request that the services of a competent, 
physician be at once summoned. 

BELLADONNA. 

Belladonna was so called by the Venetians, because according 
to some writers, it entered into the composition of a cosmetic 
employed by the Italian ladies. Others will have it that the 
visions of beautiful women which it sometimes excites conferred, 
its name upon the plant. Its popular name (deadly nightshade), 
which is of German origin, is probably derived from the poisonous 
qualities with which ever}* part of the plant is endowed. Bella- 
donna is administered internally as an anodyne, in all forms of" 
pain; in neuralgia, spasms, etc., and sometimes to procure sleep. 
It is likewise a capital remedy in the wasting night sweats of 
phthisis and rheumatism. Its active principle, sulphate of atropia, 
is largely employed by oculists to dilate the pupil, and in diseases 
and operations of the eye in general. Atropia mixed with oil of" 
sweet almonds is the best reined}- known for earache, when 
dropped into the ear. 

The extract of belladonna in suppositories is very valuable 
in painful hemorrhoids. The medicinal dose of belladonna is % 
of a grain of the extract, 15 to 20 drops of the tincture, and of 
the sulphate of atropia 1-50 to 1-20 of a grain. The treatment, 
for poisoning by belladonna is exactly the same as in stramonium 
poisoning. Opium is likewise the physiological antagonist or 
antidote.* 

*See Opium. 



POISONS AND THEIR ANTIDOTES. 59 

HENBANE. 

Hyoscyamus or Henbane. The name of this medicine is 
derived from two Greek words, "hus," a hog, and " kuamos," 
a bean, indicating that it is a kind of food of which hogs are fond. 
The vulgar name, henbane, refers to its poisonous effect upon 
fowls. The plant is a native of Europe, but naturalized in the 
United States. When mature it is from two to four feet in height ; 
the leaves are large, long, deeply incised, like the stem, hairy, 
and of a pale green color ; at the upper part of the stem they are 
sessile, soft, cottony, and clammy, and exhale a foul, heavj^ and 
sickening odor, which has been compared to that of the black 
currant. From its resemblance to certain edible tap-roots, and 
particularly that of the parsnip, it has frequently been eaten by 
mistake and produced poisonous effects. Hyoscyamus taken 
internally, like belladonna, dilates the pupils and like it acts as a 
nerve sedative, but is more depressant in its action. Used in 
mania, conditions of spasm (convulsions, colic and whooping 
cough) , etc. Dose of the solid extract 2 grains. Fluid extract, 
5 to 10 drops. Tincture y 2 to 1 teaspoonful. Antidote and treatment 
for poisoning by hyoscyamus is the same as that recommended by 
poisoning from belladonna and stramonium.* 

OPIUM AND ITS ALKALOID, MORPHINE. 

Opium is the concrete juice of the unripe capsules of papaver 
somniferum. This is a species of poppy of which there are 
several varieties. It is a native plant of Asia, but now grows 
wild, or is cultivated in every part of Europe and the United 
States. Its culture for the production of opium has been chiefly 
carried on in India, Persia, Egypt, and Turkey in Asia, and of 
late years in the south of France. The principal constituent of 
opium is morphine, but it also contains other alkaloids, as 
codeine, narceine, papaverine, and others, which in the main 
resemble morphine in their action. 

Opium is obtained from the capsules as soon as their 
leaves are fallen, by making superficial incisions from which 
the juice flows and concretes in grains or tears. Opium in 
pow T der, tincture, or morphine is very largely employed in 

*See Belladonna and Stramonium. 



GO POISONS AND THEIR ANTIDOTES. 

medicine for the alleviation of pain of all kinds ; in insomnia 
(sleeplessness), especially when due to pain ; hiccough, colic, 
cramp of the stomach, cough, inflammation of the peritonium, 
bladder, pleura and lungs. In fever it allays delirium and 
procures rest and sleep. In the form of Dover's powder it is an 
invaluable remedy to produce diaphoresis (sweating), in acute 
catarrhal inflammations or rheumatism. It is also used locally as 
an anoclyne and astringent. 

When taken in an overdose it produces unbearable drowsiness 
or coma (profound sleep), with dry, dusky skin, stertorous, (loud 
snoring,) very infrequent breathing, slow, full pulse and very 
contracted pupils, causing death from respirator}' failure. 

Taken habitually opium causes a state of mental and physical 
depression, with deterioration of moral character and other bad 
symptoms. While the writer would not like to say that the 
opium habit directly, shortens life, he is, however, cognizant that 
it often makes life so miserable and burdensome that he would 
enjoin upon all, not to fall into this direful habit. It should be 
remembered that children bear opium very badly and it should 
onlj- be administered to them with the greatest caution. 

The medical doses, for adults, of the chief preparations 
of opium are as follows : Powder, i to 2 grains ; tincture 
(laudanum), 20 to 30 drops ; sulphate of morphine }i to l /± 
grains ; tincture opii camph. (paregoric), one to two teaspoonfuls. 
Children proportionately smaller doses. Morphine is now 
generally administered hypodermically (in the same doses as per 
mouth) by physicians and is frequently combined with sulphate 
of atropia. Its action by this method is much quicker and more 
effectual, and likewise safer, as the doses can be better controlled. 
Given per mouth its action will be greatly modified by the 
contents of the stomach — which if full will retard its action very 
much. 

As opium and its preparations produce narcotism, in so far 
only as they are absorbed, and as no chemical re-agent is known 
by means of which the active principles of the narcotic can with 
certainty be rendered insoluble in the stomach, there remain no 
other modes of procedure, when a poisonous dose of opium has 



POISONS AND THEIR ANTIDOTES. 61 

been swallowed, than to remove it from the stomach, and then, if 
its constitutional effects appear, to combat them b} T means of 
stimulants or antidotes addressed to the nervous system. 

The primary indication which has been mentioned is often 
difficult of fulfilment, for the nervous system is already benumbed, 
when medical aid is sought and the emetics which operate by 
direct contact with the extremeties of the nerves concerned in the 
act of vomiting, no longer produce this result, or only the more 
powerful among them, and in very large doses. In mild cases, 
and when the drug has been very recently taken, a dose of 
ipecacuanha will generally suffice to procure its rejection, or a 
copious draught of tepid water containing mustard or salt may 
answer the same purpose. 

If these fail, sulphate of zinc, in doses of from one to two 
drachms should be given ; and even a still more powerful emetic, 
sulphate of copper, ma}' be administered instead, in six grain 
doses. Plenty of strong coffee without milk or sugar is a domestic 
remedy that is quickly obtained. 

Atropia, the active principle of belladonna, is the most 
valuable physiological antidote. It should be administered hypo- 
dermically at the onset or immediately upon the arrival of a 
physician and may be given before the trial of emetics as it does 
not at all retard their action. Electricity properly employed is 
another means of stimulating the respirations, which in opium 
poisoning frequently drop to eight or less per minute in desperate 
cases. 

Artificial respiration, motion and friction are imperative. As 
a matter of course skilled medical aid should be promptly 
employed. The writer would in this connection state that 
permanganate of potassium has quite recently been suggested as 
a sure chemical antidote for the alkaloids of opium, especially 
morphine, but at this writing the matter has not been sufficiently 
tested to merit more than a passing notice. 

STRYCHNINE AND NUX VOMICA. 

Strychnos Nux Vomica, or poison-nut, is a middling-sized 
tree of the coast of Coromandel and other parts of India, which 



<32 POISONS AND THEIR ANTIDOTES. 

bears a round, smooth beny, the size of a pretty large apple, of 
a rich orange color, and containing numerous seed imbedded in a 
iuicy pulp. The seed, which are odorless and intensely bitter, 
are the officinal portion. Strychnine is the alkaloid and active 
principle of nux vomica. 

Medicinal Uses. — This medicine is our chief resource in 
torpid or paralytic conditions of the motor or sensitive nerves, or 
of the muscular fiber. When, however, paralysis is the result of 
inflammation of the nervous centers, it is injurious, and accelerates 
organic changes. It is most beneficial in those forms of paralysis 
which are independent of structural lesion, as lead-palsy, or 
paralysis from drunkenness. In paralysis arising from cerebral 
haemorrhage, after the absorption of the effused blood, when the 
paralysis remains, it is almost certain to do very much good. In 
these cases, str} T chnine is recommended in doses of gr. 1-30 injected 
into the corresponding temporal region. It should be administered 
daily, and the dose increased until slight twitchings of the 
muscles are produced. It has also been found beneficial in 
constipation, dysentery, cholera, diarrhoea, sexual impotence, 
incontinence of urine, spermatorrhoea, and other affections 
depending on functional atoiry and relaxation of muscular fibres ; 
in chorea and in epilepsy it is highly recommended ; and in 
small doses, it has been used with excellent effect, as a general 
tonic where there is loss of nerve-power, and also as a stomachic 
in dyspepsia, and to relieve the vomiting of pregnane}'. 

Strychnine now holds a very high rank as a therapeutic 
agent in the practice of medicine. It is one of the very best 
remedies in heart-failure from shock and otherwise, and is best 
administered hypodermatically. The dose of the tincture of 
nux vomica is from 5 to 20 drops ; of the sulphate of strychnine 
1-60 grain. 

A tolerance of nux vomica and strychnine is rapidly 
established in the system and much larger doses will be borne. 

The smallest quantity of nux vomica which is known to have 
caused death is said to have been 3 grains of the alcoholic extract. 
Of strychnia, the least dose which is recorded, as having proved 
fatal appears to be 1 grain. . Recover} 7 , however occasionally takes 



POISOXS AND THEIR ANTIDOTES. 63 

^place after very large doses, such as 3 or even 4 grains of 
strychnine, have been taken. 

Antidotes and Treatment for Poisoning by Nux \~omica and 
Strychnine. — The object of treatment should be the prevention 
of the absorption of the poison in the stomach, by prompt emetics, 
and by tounteracting the nervous derangement and excitement 
which result from its absorption Bromide of potassium in doses 
of 30 grains, or 20 grains chloral, or both, to an adult. Tannic 
acid is a valuable chemical antidote and prevents the absorption 
of the poison. Opium and camphor in large doses are also very- 
valuable to allay the tetanic spasms or convulsions which the 
poison produces. The greatest quiet must be secured and the 
poisoned person should be put to bed in a darkened room, with 
doors, windows, and shutters arranged in a way that should 
exclude all light, sounds and draughts, though permitting 
ventilation. It is unnecessary to remark that prompt and skilled 
treatment must be instituted, as these poisons destroy life very 
rapidly if not scientifically combated. 

DIGITALIS (FOX-GLOVE.) 

This beautiful plant of the garden, cultivated in this country 
for its flower, and used, in proper quantities, is a valuable 
-medicine, it being the best heart tonic we possess ; and is used in 
a great mam* affections. 

Digitalis is also one of the most generally useful remedies in 
drops}* which we have. It is of course, especially indicated in 
the mechanical drops)* of valvular lesions. In renal dropsy, of 
all drugs, digitalis is of the greatest value ; and the best form in 
which, to administer it is the infusion. Several da}*s usually 
elapse before very decisive results are achieved, but the flow of 
urine is, then, often enormous. 

Medical Doses. — Digitalis ma3* be given in powder, dose 
1 grain two or three times a day ; Abstract doses % grain to 
1 grain ; Infusion, dose 2 to 4 fluid drachms ; Tincture, dose 5 
drops to 1 fluid drachm ; the Extract (alcoholic), dose % grain, 
gradually increased ; Fluid Extract, dose, 1 drop to begin with. 
If digitalis produces wakefulness, a little opium may be combined 



64 POISONS AND THEIR ANTIDOTES. 

with it. Digitalis is, however, a poison of the narcotic class, with_ 
a disposition to overcome that portion of the nervous system 
controlling the action of the heart. The same treatment should 
be pursued when digitalis has been taken in poisonous quantities, 
as recommended for other narcotics. The peculiar tendency to 
stop the action of the heart should be especially combated by 
giving 20 or 30 drops of aromatic spirits of ammonia every 3 or 
4 minutes in a tablespoonful of water, or some other stimulant. 



ACONITE. 

Aconitum Napellus, aconite, wolfsbane, or monkshood, is a 
native of the mountainous parts of Europe and Asia. The roots 
and leaves are the portions used in medicine. It is brought from 
Europe, India and Japan. The active principle of aconite is an. 
alkaloid named Aconitine, which is an exceedingly virulent poison, 
more powerful when pure than hydrocyanic (prussic) acid. 
This agent is scarcely adapted to internal use, as even 1-50 of a 
grain has produced alarming results, but as a local agent in 
neuralgia and rheumatism, it has been employed with great 
success. 

Aconite is a powerful and valuable remedy in the treatment 
of neuralgia, chronic rheumatism, gout, and other painful 
diseases, as might be inferred from its benumbing effects on the 
system. From its influence on the circulation, it is employed to 
reduce inflammatory action, to moderate an excessively rapid 
pulse in scarlatina and other fevers, and as a remedy in 
enlargement and other cases of excessive action of the heart. 
It is contraindicated when the heart is weak from any cause, as 
dilatation, or in valvular incompetency. In pleurisy, pericarditis, 
also in pneumonia, before the exudative stage, aconite is a 
good remedy and is given until its effects are obtained. 
Aconite has done much good in relieving an attack of tonsilitis. 
In controlling abnormal cardiac action aconite is perhaps the most 
available article, for this purpose, we possess, but its employment 
requires caution. As an external application in neuralgia, it has 
no snperior. 



POISONS AND THEIR ANTIDOTES. 65 

Poisoning and Treatment. — Aconite aside from being taken for 
suicidal purposes, or in mistake for whiskey which it so much 
resembles in odor, color, and taste, aconite is sometimes contained 
in liniments, and swallowed by mistake. In all such cases 
vomiting must be brought on speedily, followed by the administra- 
tion of stimulants, aromatic spirits of ammonia in teaspoonful 
doses, wine, whiskey, or brand}'. Strong coffee may also be 
used. If there is depression, warmth must be used as described 
when speaking of unknown poisons, and the attention of a 
physician is imperative. 

The preparations of aconite kept in our drug stores, are the 
tinctures of the root and leaves. The dose of the tincture of the 
root is from 3 to 5 drops and that of the tincture of the leaves 
5 to 10 drops. The dose of the extract of aconite is from ^ to 
1 grain. 

LOBEUA (INDIAN TOBACCO.) 

This vegetable is not now much used as a medicine by 
ph\-sicians, as the comparatively recent discoveries in chemistry 
have added substitutes to the list of drugs, without the peculiar 
disadvantages of this substance. Fortunately one of the symptoms, 
following its use is vomiting. This should be encouraged by- 
drinks of tepid water, gum-arabic water, etc., and, if kept up- 
until all the poison is rejected hy the stomach, a favorable issue 
may be expected. Should vomiting not occur at once, as a 
symptom, enough of the poison may be absorbed into the blood, 
to exert a fatal narcotic influence upon the brain and nervous; 
system ; or perhaps, to speak more precisely, through these: 
organs upon the movement of respiration and circulation of the, 
blood. 

TOBACCO (NICOTIANA TABACUM). 

The specific name of the tobacco plant is derived by Neander, 
one of the earliest of the numerous writers upon the subject, 
from Tabaco, a province of New Spain, situated about forty- 
four miles from the city of Mexico, and which afterwards 
was called ' ' Our I,ady of Victory, ' ' in commemoration of a battle 
there won by Cortez, in 15 19. The generic title was conferred 



66 POISONS AND THEIR ANTIDOTES. 

in honor of John Xicot, of Nismes, ambassador of France, at 
the court of Portugal, in the year 1560. At Lisbon he was 
presented with a specimen of the plant, recently brought from 
Florida, and caused it to be cultivated in his garden. On 
returning to France he presented some of its seed to the queen, 
who encouraged its culture. From these circumstances it was' 
named The Ambassador s Plant, The Queen's Plant, etc., and, 
indeed it was called by many other titles which have been 
forgotten, in favor of his whose influence chief!}- promoted its 
culture in Europe. It would appear that the luxurious uses to 
which tobacco is at present chiefly applied, were but little 
regarded, until the return of Sir Francis Drake from Virginia, in 
1586. This officer brought with him some of the pipes used by 
the aborigines, and so introduced the practice of smoking, which 
soon became fashionable under the patronage of Sir Walter 
Raleigh, and the gentlemen of the court. Tobacco plants were 
found b} T Cartier, in Canada, in 1535, to be held in great esteem 
by the Indians, and a century later Hawkins described it as a 
favorite luxury of the natives of Florida. Although the use of 
tobacco rapidly became general, there were not wanting many 
writers to decry it, and attribute to its use a multitude of 
mischiefs. The Pilgrim Fathers of Xew England and their 
descendants distinguished themselves by enactments against the 
use of the weed. Tobacco is now cultivated in almost every part 
of the world, and after having been rigidly interdicted by several 
governments of Europe, has become one of the most fruitful 
sources of revenue. 

Tobacco is emplo3 T ed as a remedial agent in medicine — both 
internally and externally. To a person not accustomed to its 
effects, b}~ beginning with small quantities, and persisting in its 
use, tobacco is an acro-narcotic (irritant and stupefying) poison, 
agreeing in its essential character with aconite and others of the 
same general class. The movements of the heart become so 
much interfered with that death ma}' take place unless proper 
assistance is at once given. Fortunately, like lobelia, it acts as 
an emetic, and before enough can be absorbed into the blood 
from the stomach, the contents of that organ are rejected. Hence, 



POISONS AND THEIR ANTIDOTES. b* 

when" death has ensued from the direct use of tobacco, we find 
that it was used as an injection, a form in which it should never 
be given. 

SAVINE. 

This is an active irritant poison inflaming the stomach and 
bowels. When thus taken, vomiting, by tickling the throat with 
the finger or feather should be induced. The mucous membrane 
(lining) of the bowels should be protected from the irritant action 
of what has escaped beyond the stomach before it could be 
emptied by vomiting, by drinking large quantities of water or 
milk, with good quantities of gum-arabic dissolved in it. If the 
oil of savine, which is the usual form of the substance when used 
with a criminal intent, has been taken, it might be well to take a 
dose of castor oil. 

POISONING BY MUSHROOMS. 

Persons not well acquainted with the difference between the 
poisonous and edible mushrooms had better buy them of those 
w T ho are, or go without. There are distinctions between them, 
but they are not of such a character as can be made evident in a 
place like this. When poisoning from eating mushrooms does 
take place, the contents of the stomach should be evacuated by 
an emetic. After vomiting has commenced, it should be promoted 
by draughts of warm water, barley water, but particularly by 
drinking copiously of warm milk and water, to which sugar has 
been added. What has passed along into the bowels should be 
hurried out as fast as possible, by some cathartic, before further 
absorption into the blood can take place. Castor oil might be 
peculiarly useful in such a case. If there is much prostration of 
the strength, some easily procured stimulant might be useful, as 
the spirits of ammonia or brandy. 

POISONOUS MEATS. 

Eating meats of diseased animals is often followed by 
symptoms of a poisonous character. Animals in otherwise 
perfect health, but which have been butchered and prepared for 



68 POISONS AND THEIR ANTIDOTES. 

food after long and exhaustive confinement, are unfit for eating. 
Not only is the meat of such animals lacking in nutritive character, 
when compared with the meat of animals killed from the pasture 
without excitement, or after being kept until proper recovery from 
the effects of the journey to market, but it is much less savory, 
and shows a disposition to much more readily decompose. It 
might be here stated that it has been estimated by competent 
authorities, that between the two kinds of meat there is, in a 
commercial sense alone, as far as nutriment is concerned, a 
difference of nearly fifty per cent in favor of the meat of healthful 
animals, butchered after complete recovery from the excitement 
and fatigue of drive or carriage to market. The additional cost 
per pound of meat to cover the expenses of extra care and 
precaution before butchering, would amount to but a small fraction 
of the percentage named, leaving the rest of it a true profit to the 
cosnumer. The eating of this over-driven meat, it is said, is often 
followed by symptoms of irritation of the stomach and bowels ;: 
but they can, in the ordinary sense of the word, scarcely be said 
to be of poisonous character, however much the use of them 
may temporarily derange the health. 

POISONOUS fish. 
Several varieties of fish, at all seasons of the year, are 
reputed to be poisonous. Of course, they should always be let 
alone. Should the}' have been eaten by accident, the best- 
treatment is that given under the head of ' ' poisoning by mush- 
rooms. ' ' Shell-fish at certain seasons of the year after spawning, 
are considered poisonous when eaten ; at least, they are unhealthy. 
This process of nature is known to be very exhausting , during 
which, or just afterward, the individual is so reduced in vitality as 
to be unable to resist ordinary tendency to decomposition. Oysters 
in hot weather are often unwholesome perhaps from the causes- 
suggested ; or it may be that the collection of liquid secretion 
between the shell and the contained animal, in hot weather, is in 
a state favorable to putrefaction upon slight exposure to the air ; 
and the disagreeable symptoms often said to arise after partaking 
of this fish as food is due to this as much as anything else. 



POISONS AND THEIR ANTIDOTES. 



69 



POISONS AND THEIR ANTIDOTES. 

Resume. — We have thus completed the list of poisons that are 
at all common, and stated at length what should be done in 
almost any case that may occur. To &ave time in an emergency, 
the following table, which is alphabetically arranged, may be 
consulted, which gives the name and treatment of all the poisons 
in general. 



POISONS. 



Unknown. 



ANTIDOTES. — TREATMENT. 

Induce repeated vomiting by the 
methods already described, such 
as mustard and water, salt and 
water, etc. Administer de- 
mulcent drinks freely. If de- 
pression — stimulate with whis- 
key, ammonia and external 
heat. 



ACIDS. 

Acetic. 

Carbolic. 

Citric. 

Muriatic. 

[Hydrochloric] 

Nitric. 

Oxalic. 

Sulphuric. 

Tartaric. 

Prussic [see 

Hydrocyanic Acid.] 



Aconite. 



Alkalies — Soap, chalk, lime-water, 
magnesia, bi-carbonate of soda 
solution, carbonate of soda, 
plaster off wall in emergency. 
Mucilaginous drinks, barley- 
water, milk. The fixed oils 
[except in carbolic acid.] The 
stomach pump not to be used 
[except in carbolic acid] . Se- 
cure rest and relieve pain by 
morphine hypodermically. Sti- 
mulate if necessary. 

Emetic or stomach pump. Stimu- 
lants, external and internal. 
Keep up external heat. Keep 
flat on back. Hypodermic in- 
jections of digitalis. 



POISONS AND THEIR ANTIDOTES. 



Antimony. 

[Tartar emetic, etc.] 



Antidotes and treatment. 

Vegetable acids, such as tannic acid, 
catechu ; albumen [white of" 
eggs] , mucilage ; opium and, 
stimulants. 



Ammonia. 



Arsenic. 



Atropia [the active 
principle of belladonna] 



When taken by inhalation, inhala- 
tions of chloroform to relieve 
spasm ; when swallowed, dilute 
vinegar, lemon-juice, olive-oil, 
milk ; do not use stomach- 
pump. 

Stomach pump and emetics. Freshly 
precipitated hydrated sesqui- 
oxide of iron, made by adding 
magnesia to any iron solution. 
Give dose castor oil. Opium 
and alcoholic stimulants for 
systemic depression. 

Emetics — mustard , flour and water ; 
give pilocarpine, opium or mor- 
phine. The caustic alkalies 
destroy the active principle, 
but the available chemical anti- 
dotes are tannin, compound- 
solutions of iodine, charcoal, 
etc. Cold to the head. 



Belladonna. 



Same as atropia. Opium or mor- 
phine for cerebral symptoms, 
but not pushed to excess. 



Camphor. 



Alcohol ; emetics ; caffeine ; the 
arterial sedatives, etc. 



POISONS AND THEIR ANTIDOTES. 



71 



Canthandes. 



CAUSTIC ALKALIES : 

Caustic Potash. 

Caustic Soda. 
Caustic Lime, etc. 



Carbolic Acid 



ANTIDOTES. — TREATMENT. 

Emetics ; castor oil ; demulcent 
drinks [not containing oil] ; 
opium by enema ; warm baths ; 
poultices to abdomen. 

Dilute vinegar or lemon juice ; 
demulcent drinks ; olive oil in 
quantities [forms soap] ; milk ; 
morphine hypodermically for 
pain and rest ; stimulants for 
collapse. 

A soluble sulphate [epsom salt, 
Glauber's salt] ; emetics, stom- 
ach-pump; bi-carbonate of soda, 
lime water and chalk ; mucila- 
ginous drinks ; heat to extreme- 
ties, digitalis and strychnine for 
collapse. 



Chlorine Water. 

Chlorine Gas. 

Cannabis Indica. 
[Indian Hemp.] 



Chloral Hydrate. 



of egg~\ ; milk 



Albumen [white 
flour. 

Ammonia. 



Caustic alkalies ; strychnine 
die electricity. 



fara- 



Stomach pump [safer than emetics] , 
ether, ammonia, atropia, whis- 
key or digitalis hypodermi- 
cally ; head lowered, heat and 
galvanism to overcome heart 
depression. Strychnia is a re- 
commended antagonist, but its 
range is limited. 



72 



POISONS AND THEIR ANTIDOTES. 



POISONS. 



Chloroform. 



Colchicum. 



Conium. 



Copper Sulphate. 



Corrosive Sublimate. 



Curara or Woorara. 



ANTIDOTES. — TREATMENT. 

Fresh air ; artificial respiration [in- 
clining head down, pull tongue 
forward] ; hypodermic injection 
of ether, brandy, strychnine, 
digitalis or atropine ; a single 
whiff of amyl nitrite ; heat : 
friction ; electricity, etc. 

Emetics, followed by demulcent 
drinks. If coma be present, 
brandy, ammonia, coffee. Opi- 
um in large dose ; keep up 
external heat. 

Emetics, followed by stimulants, 
external and internal. 

Yellow prussiate of potash or soap. 
Sweet-oil or albumen [white of 
egg] and emetics and the usual 
systemic remedies. 

Albumen [white of egg] , [4 grains 
sublimate require white of one 
egg] , flour, milk. Equal parts 
of lime water and milk. Emet- 
ics, or evacuate stomach by 
pump. Heat to body and 
stimulants hypodermically. 

Caustic alkalies and tannin act 
chemically ; artificial respira- 
tion is of importance. Cold 
effusion and emetics are neces- 
sary. Atropine and strych- 
nine to counteract the respira- 
tory failure. 



POISONS AND THEIR ANTIDOTES. 



Y3 



POISONS. 



Croton Oil. 



Digitalis. 



ANTIDOTES. — TREATMENT. 

Emetics ; wash out stomach, fol- 
lowed by mucilaginous fluids, 
containing opium. 

Emetics or stomach pump and opi- 
um ; give tinct. aconite, amyl 
nitrite ; tannin [or green tea] ; 
sulphate of iron, is a chemical 
antidote. Recumbent position 
after emetics. Stimulants not 
given even when pulse is weak. 



Elaterium. 
"[Squirting Cucumber.] 

Ergot. 



Ether. 



Gold Chloride. 



'Gelsemium or ' ' Yellow 
Jasmine." 



^Hedragogue Cathartics. 



Demulcent drinks, enemata of opi- 
um, and external heat. Stimu- 
lants and proper aliment. 



The caustic alkalies ; aconite 
especially amyl nitrite. 



but 



Artificial respiration ; head lowered 
if face is pale, otherwise not ; 
strychnine, atropine, digitalis 
or ammonia hypodermically ; 
friction, heat, flagellation, gal- 
vanic battery, cold affusion. 

Same as mercury. 

Chemically, caustic alkalies, and 
tannic acid. Emetics, warmth 
ammonia, artificial respiration, 
and morphine, sub-cutaneously, 
are the important measures. 

Demulcents, opium and stimu- 
lants. 



74 



POISONS AND THEIR ANTIDOTES. 



Hydrocyanic Acid 

[Prussic] 

and Cyanide of 

Potassium. 



ANTIDOTES. — TREATMENT. 

Cold affusion to the spine, inhala- 
tions of ammonia ; electricity ;. 
artificial respiration ; the in- 
jection of atropine, carbonate 
of potassium 20 grains in water, 
are the best expedients. Emetics 
should be given if there is 
time. 



Hyoscyamus . 



Stomach pump ; emetics ; and 
chemical antidotes and. antago- 
nists same as for belladonna. 



Illuminating Gas. 
[Common Burning Gas.] 



Fresh air : h3'podermic injections of 
nitro glycerine ; artificial respi- 
ration and stimulants are recom- 
mended by Prof. Kloman of 
Baltimore. 



Iodine, and its poisonous 

compounds. 

Iodoform. 



Lead- Acetate. 
[Sugar of Lead.] 



Starch is the antidote for iodine ;; 
but as the iodide of starch is 
not without power, emetics 
should also be given. Albu- 
men, starch, lime water, tannin, 
soap, etc., should be used in- 
poisoning by iodides, and free 
vomiting induced. Strychnine, 
atropine, alcohol, ammonia, or 
digitalis hypodermically. 

Diluted sulphuric acid ; alum ; 
epsom salt ; milk ; hot applica- 
tions to bell} 7 and feet ; opiates 
for pain ; white vitriol as 
emetic. Use purgatives, and 
iodide and bromides to secure 
elimination. 



POISONS AND THEIR ANTIDOTES. 



<^> 



POISONS. 

Lobelia. 
[Indian Tobacco.] 

Morphine. 



Muscarine or 
The Flv-Funerus. 



Mercury and its 
compounds. 



Mushrooms and 
Toadstools. 

Nux Vomica and 
its alkaloids. 



Nitro- glycerin and 
Nitrite of Amyl. 



ANTIDOTES. — TREATMENT. 

Stimulants externally and inter- 
nally ; external heat. 

Same as opium. 

A complete antagonism exists be- 
tween atropine and muscarine ; 
also digitaline and eserine are 
antagonists. 

Albumen [white of Qgg~\, tannin, 
lime-water, should be administ- 
ered freely. Emetics should 
be given. For the usual sys- 
temic depression, opium, alco- 
holic stimulants, etc. 

Atropine ; heat and stimulants ;; 
emetics. 

30 grains of chloral and 60 grains 
of bromide of potash. Nitrite 
of amyl. Tannin is a chemi- 
cal antidote. Stomach-pump. 

Ammonia, cold affusion, and arti- 
ficial respiration ; strychnine 
and atrophia sub-cutaneously, 
also ergot, a true physiological 



Opium or Laudanum. 



Atropine hypodermatically till res- 
pirations number 8 per minute. 
Stomach pump, stimulants ex- 
ternal and internal, brandy and 
coffee, cold affusion, ammonia 
to nostrils, galvanic shocks, 
compelling to move about, arti- 
ficial respiration, electric brush. 
Permanganate of potassium. 



76 



POISONS AND THEIR ANTIDOTES. 



POISONS. 



Phosphorus. 



Potash and Soda salts. 



Picrotoxin. 



Pilocarpus. 



Physostigma. 



Salicylic acid. 



Silver Nitrate 
[Lunar Caustic] 

Soda. 

Stramonium . 
Strychnine. 



ANTIDOTES. —TREATMENT. 

Sulphate of copper in emetic dose 
as chemical antidote. Ozonized 
oil of old turpentine [not fresh 
oil of turpentine nor any other 
oils.] Emetics and purgatives. 
Stimulants for collapse. 

Dilute acetic acid, citric acid, lemon 
juice, fixed oils, demulcents, 
vinegar. 

The physiological antagonists and 
antidotes are the same as for 
strychnia. 

Atropine is in a very complete de- 
gree, the physiological antago- 
nist ; heart stimulants, as am- 
monia and alcohol, antagonize 
the heart's weakness. 

Emetic. The vegetable astringents 
and tannin are antidotes. 

Respiratory stimulants [strychnine, 
atropine, ammonia] ; application 
of heat. 

Common salt ; oily and mucilaginous 
drinks, milk or soap and water, 
white of egg ; emetics, appli- 
cation of heat and stimulants. 

See Alkalies. 

Same as belladonna. 

Same as nux vomica. 



POISONS AND THEIR ANTIDOTES. 



77 



Resorcin. 



Tobacco or Nicotine. 



Turpentine. 



Veratum Viride. 
[American hellebore.] 



Zinc salts [chloride 
and sulphate.] 



ANTIDOTES. — TREATMENT. 

Arterial and respiratory stimulants 
prevent the cardiac depression, 
especially atropine. 

Emetics, stomach-pump, tannin, 
compound solution of iodine, 
chemical antidotes. Ammonia, 
brandy, strychnia, atropia, to 
overcome failure of respiration ; 
also artificial respiration. 

Emetics, diluents, and demulcents. 
Opium is the most important 
remedy to counteract the irri- 
tation. 

Ammonia, alcohol, artificial respi- 
ration, heat, atropine or mor- 
phine sub-cutaneously ; also 
digitalis. 

Carbonate of soda, emetics, warm 
demulcent drinks. White of 
egg- 



CHAPTER VIII. 
Materia Medic a axd Therapeutics. 

Tharmacy. The Derivation of Medical Agents. Hygienic — Mechanical — Imponderable 
and Medical. Blood-letting by Venesection, Cupping and Leeches. Light, Heat. Cold 
and Electricity. The Modus Operandi and Application of Medicines. The Different 
Methods Given, and the Circumstances Modifying Their Action Fully Described. 
Apothecaries' Weight and Measures. Abbreviations and Symbols Used in Writing 
Prescriptions and in Medicine generally. The Classification of Medicines According 
to Their Action on the Animal Economy, Fully Defined. Diuretics— Emetics— Tonics- 
Astringents— Diaphoretics— Narcotics — Emmenagogues — Cathartics — Antacids — Anti- 
spasmodics — Irritants — Demulcents — Anthelmintics — Anaesthetics — Spinants — Altera- 
tives — Antiseptics — etc. 

Medicinal agents are obtained from the animal, vegetable and 
mineral kingdoms. 

The agents employed in the treatment of diseases are 
denominated remedies, and the branch of medicines which is 
devoted to their consideration is termed Materia Medica. 

Remedies may be divided into hygienic, mechanical, imponder- 
able and pharmacological (medical) agents. 

Mechanical remedies are blood-letting (bleeding) (general and 
local), seions, issues, bandages, friction, acupuncture , and aspira- 
tion. Blood-letting is performed by venesection or phlebotomy 
which is usually practised on the median-cephalic or basalic veins 
of the arm. 

Local abstraction of blood is practised by means of leeches 
(blood-suckers) cupping and scarifications. 

The imponderable remedies are light, heat, cold and electricity. 

Pharmacological (medical) remedies, or medicines, are sub- 
stances not essential!}' alimentary, which, when applied to the 
body, so alter or modify its vital functions as to be rendered 
applicable to the treatment of diseases. 



Materia Medic a and Therapeutics. 79 

The designation materia medica, or pharmacology, is, stridly 
speaking, limited to the consideration of medicines. The 
application of medicines to the treatment of diseases is termed 
therapeutics. Pharmacy is the department of materia medica 
which treats of the collection, preparation, preservation, and 
dispensation of medicines. 

The effects of medicines take place either in the parts to 
which they are applied or in distant parts of the system. The 
former are termed local or topical effects; the latter, remote or 
.constitutional effects. 

The medium through which the influence of medicine is 
exerted on remote parts of the bod)' is called modus operandi. It 
is now generally admitted that the absorption or passage of the 
medicinal or poisonous molecules into the blood is necessary to 
their action on parts remote from the seat of impression. The 
absorption of medicines is effected principally by the veins, and 
in some degree also by the lymphatics and lacteals. The medici- 
nal particles penetrate or soak through the interstices of the tissue 
with which they are placed in contact, and are thence diffused 
through the circulation. The absorption of insoluble substances 
■cannot take place until they are previousfy rendered soluble. In 
the stomach, this is accomplished partly by the agency of the 
acids of digestion, and partly hx the albuminoid constituents 
of the gastric fluid. Some substances are dissolved by the alka- 
line liquids of the small intestine. 

The circumstances which modify the effects of medicines 
relate both to the medicines and to the human system. 

i. The properties of medicines are modified b3^ the soil in 
which they grow, b} T climate, cultivation, age, and the season of 
the year at which they are gathered. 

2. Medicines are more active, because more readily absorbed, 
in a state of solution than in a solid state. 

3. Soluble medicines are often rendered inert by a chemical 
re-action which converts them into insolubles, or by a physiologi- 
cal antagonism, exerted by some other medicine taken at or about 
the same time, which counteracts their effects throughout a part 
•or the whole of their range of action ; in this way, chemical and 



80 Materia Medica and Therapeutics. 

physiological antidotes modify the effects of poisons. When the 
chemical composition of medicines involves their mutual decom- 
position, they are said to be incompatible. 

4. Differences in dose greatly modify the effects of 
medicines. 

5. Pharmaceutical modifications have an important influence 
on the efficacy of medicines. They may be exhibited in the solid, 
semi-solid, liquid, and aeriform states. 

In the solid state, they are administered in the shape of 
abstracts, triturations, extracts, powders, pills, lozenges, confec- 
tions, and papers. 

In the liquid state, they are administered in the shape of 
fluid extracts, mixtures, solutions, medicated waters, infusions, 
decoctions, tinctures, spirits, wines, juices, vinegars, honeys, 
syrups, and glycerites. 

In the semi- solid, or soft state, they are employed internally- 
in the form of suppositories, and externally, in that of liniments, 
ointments, cerates, plasters, and cataplasms (poultices. ) 

In the form of gases and vapors, medicines are used for 
purposes of inhalation. 

Infusions are partial solutions of vegetable substances in 
water, obtained without the aid of ebullition or boiling. They 
are made with both hot and cold water. 

Decoctions are partial solutions of vegetable substances in 
water, in which the active principles are obtained by boiling. 
This is a more rapid and efficient mode of extracting the 
virtues of plants than by infusion. But it is objectionable- 
when the proximate principles are volatile at a boiling heat or 
undergo decomposition by ebullition. In making decoctions 
boiling should be continued for a few minutes only and here I will 
say the same rule applies to the making of coffee and tea. 

WEIGHTS AND MEASURES. 

In prescribing and dispensing medicines the following are the 
weights and measures employed in the United States, with their 
signs annexed. 



MATERIA MEDICA AND THERAPEUTICS. 81 

APPROXIMATE MEASURES. 

i teaspoon (holding 60 drops of pure water) = 

about one drachm, 3L 
1 tablespoon = about one half ounce, 5ss. 

1 wineglass = about two ounces, §ii. 

1 tea-cup = about four ounces, giv. 

1 coffee-cup = about eight ounces, sviii. 

Medicines should be measured in a graduated glass, or doses 
•of less than a drachm in a minim-tube, both of which can be 
procured at an}' drug-store. Spoons are of very variable capacity, 
and drops differ with the consistence of the fluid and the shape 
of the edge over which they are poured, so that they can be with 
the greatest care only approximate measures. A minim, the 
smallest accurate liquid measure, is equivalent to about one drop 
of an aqueous solution, but it makes three or four of chloroform. 
The minim of any tincture is usually two drops, of a fluid extract 
out one. 

JIEANING OF ABBREVIATIONS AND SYMBOLS USED IN WRITING 

PRESCRIPTIONS. 

AA, ana, of each. 

Add, adde, add to it. 

Ad. lib., ad libitum, as you please. 

Alt. hor., alternis horis, every other hour. 

Alt. noc. , alterna node, every other night. 

Applic, applicatur, apply. 

Aq. dest. , aqua destillata, distilled water. 

Aq. pur., aqua pura, pure water. 

E. i. d. , bis in dies, twice a day. 

C, conguis, a gallon. 

Cap. , capiat, let him take. 

Comp., compositus, compound. 

Conf., confectio, a confection. 

Cort., cortex, bark. 

Decub., decubitus, lying down. 

Det., detur, let it be given. 

7 



82 MATERIA MEDIC A AND THERAPEUTICS. 

Dil. , dilutus, dilute. 

Div. in p. aeq. , dividatur in partes czquales, divide in equal 
parts. 

Drachm, drachma, a drachm. 

Kmp. , emplastrum , a plaster. 

Fl. or i.,fluidus, fluid. 

Ft.,yW, let there be made. 

Garg., gargarisma, a gargle. 

Gr., grana, a grain. 

Gtt., gutta, a drop. 

Guttat, guttatim, by drops. 

Inf., infusum, an infusion. 

I nj ect , , injectio , an in j ection . 

I^b., libra, a pound. 

L,iq. , liquor. 

L,ot., lotto t a lotion. 

M., misce, mix. 

Mist., mistura, a mixture. 

N. , node, at night. 

No., numero, in number. 

O. , octarius, a pint. 

OL, oleum, oil. 

Ov., ovum, an egg. 

Pil., pilula, a pill. 

P. r. n., pro re nata, as occasion. 

Pulv., pulvis, a powder. 

Q. S. , quantum sufficit, as much as is sufficient. 

R., recipe, take. 

Rad., radix, root. 

S. or Sig. , sigma, write. 

Sem. semen, seed. 

SS. or s., semis sis, a. half. 

S. V. G. , spirilus vinigallici, brandy. 

S. V. R., spiritus vini rectificatus, alcohol. 

Syr., syrupus, syrup. 

T. *i. d., ter iri dies, three times a day. 

Tr. , tinctura, tincture. 



MATERIA MEDIC A AND THERAPEUTICS. 83 

Troch., froc/iisci, lozenges. 

Ung. , ungucntum, ointment. 

m, minimum, a minim. 

5, drachma, a drachm. 

5, unci a, an ounce. 

B, scrupulum, a scruple. 

Sex, temperament, and idiosyncrasy, all modify the effects 
of medicines. Women require somewhat smaller doses than men ; 
and during menstruation, pregnancy, and lactation, all active 
treatment, which is not imperatively demanded, should be 
avoided. 

The time of administration modifies the action of medicines. 
Where a rapid effect is desired, they are to be given on an empty 
stomach ; on the other hand, irritant substances, as the arsenical 
or iodic preparations, are best borne when the stomach is full ; 
and the insoluble irons, requiring the gastric fluid to dissolve them, 
should be taken with the food. 

The condition of the stomach is to be considered in prescribing 
medicines. 

Habit diminishes the influence of many medicines, especially 
narcotics. People become habituated to their use, and as the. 
habit continues the dose must necessarily be increased. 

Medicines are applied to the skin, to mucous membranes, to> 
wounds, ulcers, and abscesses, and they are injected hypodermi- 
cally (under the skin. ) 

The application of medicines to the skin by friction, is called^ 
the epidermic method. 

A classification of medicines founded on a similarity of action 
on the animal economy, may be divided into 

Class 1. Neurotics, which are eight in number, namely — 
narcotics, anaesthetics, anti-spasmodics, tonics, astringents, 
stimulants, sedatives, spinants. 

Class 2. Kccritics, six in number, viz., emetics, cathartics, 
diaphoretics, diuretics, blennorrhetics, emmenagogues. 

Class 3. Haematics, three in number, viz., haematinics, 
alteratives, antacids. 



84 MATERIA MKDICA AND THERAPEUTICS. 

Class 4. Those which act topically or locally, five in number, 
viz., antiseptics, irritants, demulcents, coloring agents, anthel- 
mintics. 

Under Class I. are : 

1. Narcotics. — Medicines which impair or destroy nervous 
action. They are employed, chief! y, to remove muscular spasm, 
relieve pain, allay cerebral or spinal irritability and procure sleep. 

2. Anaesthetics, properly speaking, include all agents 
which diminish sensibility and relieve pain. The vapours usually 
employed to produce anaesthesia, (insensibility) are those of 
ether and chloroform. 

3. Antispasmodics are medicines that allay irregular nervous 
action. 

4. Tonics called also corroborants, are medicines which 
produce a gradual and permanent increase of nervous vigor. 
They also promote the appetite. 

5. Astringents are medicines which produce contraction and 
corrugation of the tissues to which they are applied by a local 
action. 

6. Stimulants are medicines which produce a rapid and 
temporary exaltation of the vital functions. 

7. Sedatives are medicines which diminish the frequency of 
the action of the circulation. 

8. Spinants. Under this term are comprised medicines which 
are employed to excite muscular contraction and whose ultimate 
effect is the production of motor-paralysis. 

Under Class II. , Kccritics : 

1. Emetics are medicines which are employed to promote 
vomiting ; when used merely to excite nausea they are called 
nauseants. 

2. Cathartics, also termed purgatives, are medicines which 
produce evacuations from the bowels. 

3. Diaphoretics, called also sudorifics, are medicines which 
promote transpiration or sweating from the skin. 

4. Diuretics are medicines which excite the secretion of urine. 

5. Blennorrhetics, are medicines which promote the secretion 
of the mucous membranes. 



MATERIA MEDICA AND THERAPEUTICS. 85 

6 . Emmenagogues are medicines which promote the menstrual 
discharge. 

Under Class III. , Haematics : 

i. Haematinics. This order includes only the preparations 
of iron. Their use is to increase the number of blood corpuscles, 
and are employed in diseases dependent on a deficiency of these 
elements. 

2. Alteratives ma}' be defined to be medicines which produce 
such a modification of the nutritive processes as enables the vital 
principle to restore health)' action in morbid conditions of the 
system. 

3. Antacids are medicinal agents employed to neutralize 
acids in the blood, and secretions. 

Under Class IV., Topical Medicines : 

1. Antiseptics are remedies which prevent fermentation and 
decomposition by a poisonous influence on the germs on which 
those processes depend. 

2. Irritants are medicines which are employed to produce 
irritation or inflammation of the parts to which they are applied. 

3. Demulcents are medicines which soften and relax the 
tissues, and, when applied to irritated or inflamed surfaces, 
diminish heat, tension, and pain. 

4. Coloring agents are employed exclusively for pharma- 
ceutical purposes. 

5. Anthelmintics are medicines which promote the destruction 
and expulsion of worms from the alimentary canal. 



CHAPTER IX. 
Materia Medica and Therapeutics. — Concluded. 

Quinine, Its Origin, Discover}- and History. The Use and Abuse of Quinine. Drs. A. K. 
Hill and C. A. Bryce on the Subject. Permanent Deafness as a Result of Over Doses. 
Its Value in Dyspepsia and Catarrh of the Stomach. Its Employment in Checking 
Tonsilitis, Inflamed Breasts, Pneumonia, Pleurisy and Other Inflammatory Processes. 
Peruvian Bark and Its Alkaloids : Quinine and Cinchonidia Specifics for Fever and 
Ague and Malarial Poisoning in General. The Value of Quinine in Blood Poisoning 
from the Absorption of Pus or Like Septic Matters. 

Quinine is obtained from the barks of different species of 
cinchona of which there are three principle varieties, viz., pale, 
yellow, and red cinchona. The yellow is the richest in quinine. 
It was first obtained from Peru in South America, and on this 
account is frequently called Peruvian bark. The word ki?ia, in 
the Peruvian language signifies bark, and its reduplicate kinkina, 
the native name of the medicine, means the bark of barks. This 
is the way the name quinine is derived. The systematic designation 
cinchona was applied to the species of trees producing it by Linnaeus, 
the noted botanist, in 1742, in honor of the Spanish Countess 
Cinchon, wife of the viceroy of Peru, who was one of the first to 
test the virtues of the bark , having been cured by it of intermittent 
fever. On their return to Europe about 1640 they carried with 
them a quantity of the medicine, and distributed it to the poor. 
Owing to the circumstance which led to its importation it was 
called the "Countess' powder." Yet the indifference or the 
hostility of the Spanish physicians towards it, as a new remedy, 
prevented its general use, nor was this medicine (which at the 
present day is considered one of the greatest boons to suffering 
humanity, in the whole materia medica) , accepted by the reluctant 
faculty until public sentiment in its favor was determined by an 
authoritative decision of the head of the Catholic Church. In 






MATERIA MEDICA AND THERAPEUTICS. 87 

1643, a Spanish Jesuit, Juan de Logo, was ordered by Pope 
Innocent X. to examine the bark, and on the favorable report of 
Iris Holiness' s chief physician, it was declared to be not only 
innocent, but most salutary. In 1649 or 1650, Brunacci, the 
Provincial of the Jesuits, brought a large quantity of it with him 
from America, and, a great council of the order being held at the 
time, a good opportunity occurred of sending it to all parts of 
Europe by the brethren on their return to their homes. From 
these circumstances it acquired the name of Jesuits bark or powder. 

Cinchona trees are found originally only in South America, 
in the higher regions of the Andes Mountains, where they form a 
belt of forests extending in a southwest direction from latitude 
io° X. to 1 9 S. and in breadth about forty or fifty miles. But 
are now very successfully cultivated in European and other 
■countries. The bark is the only portion of the tree that is 
employed in medicine. It is obtained by stripping the trunks and 
branches of the trees during the dry season, and is dried by 
exposure to the sun, during which process the smaller pieces 
usually become quilled, or rolled. 

While cinchona, and its alkaloids sulphate of qui?iia, and 
sulphate of cinchonidia, are admitted to be certain specifics and 
infallible remedies against malaria and malarial poisoning in 
general, and very valuable in a great many affections, the writer 
thinks, however, that their use is to a certain extent abused by 
the non-professional, at least, and would appropriately quote from 
Dr. A. K. Hill, in the Medical Times. Dr. Hill says : 

' ' Quinine is used in enormous doses, and in every form of 
disease, all over the world. A dose of twenty grains is a common 
dose. A dose of sixty grains is often given. In other words, 
quinine is given intewially, externally and eternally. It has 
taken the place that the lancet and calomel held half a century 
ago. Xow it reads, when you visit your patient and find him 
pretty bad, give him a little quinine ; if, when you again visit 
him, he is a little worse, give him more quinine ; and if, at your 
third visit, you find the patient dying, pour the quinine into him 
before it gets too late to cinchonize him so thoroughly that he 
couldn't hear an earthquake were it to occur in the next room." 



88 MATERIA MEDIC A AND THERAPEUTICS. 

' ' Undoubtedly quinine has its place as a great remedy, just as 
calomel and the lancet are good remedies if used properly and at 
the right time. But quinine should not usurp the place of other 
and better remedies in the role of tonic, oxytocic, antipyretic,, 
sedative, stimulant and antiseptic. ' ' 

As a stimulant, quinine should not be used, as this action is 
but temporary, soon to be followed by a depressant or sedative 
effect. 

' 'As a sedative, quinine has to be administered in too large 
doses to act effectively, and when thus given it is not reliable." 

' ' The action of quinine as a temperature reducer proves of 
but temporary benefit, and of permanent injury, by depressing the 
system in such a manner that the convalescence will be very much 
prolonged." 

"An agent of such general value and extensive employment 
as quinine, and one so potent for prompt and decided therapeutical 
action, is certainly liable to abuse," says Dr. C. A. Bryce, " and 
in careless hands may be productive of great harm. Quinine has 
its toxicological (poisonous) effects as surely as physiological and 
therapeutic properties. For years I have been convinced that it is 
too recklessly used by the profession, and my own experience has;, 
taught me to be more careful and discreet in its administration. 
I have so very often seen intense congestion of the nervous centers 
from overpowering doses of this drug, as well as other remote 
effects due to its impression upon the central nervous system, that 
I now consider well the size of the dose I shall administer. I 
have for a long time gradually given it in smaller and smaller 
doses, obtaining better results with fewer unpleasant symptoms,, 
just in proportion as I have brought my patient gradually under 
its physiological and therapeutic influence. ' ' 

In small doses quinine exerts a distinct stimulant effect on- 
the brain, increases the mental activity, and even exhilarates in 
some mobile (easily affected) constitutions. As some hypersemia 
(overly fnllbloatedness) is caused by it, the resulting cerebral or 
biain stimulation is probably secondary to this change in the 
vascular condition. In full medicinal doses, as the quinine 



MATERIA MKDICA AND THERAPEUTICS. 89 

accumulates in the brain, a sense of fullness in the head, 
constriction of the forehead, more or less giddiness, even decided 
vertigo, ma}- be produced. Concerning the action of quinine in 
very large or poisonous doses the celebrated Professor Bartholow, 
in his valuable Treatise on Materia Medica and Therapeutics, says : 
1 ' Dullness of hearing results from considerable doses, and deafness 
has in rare cases been permanent, and amblyopia (dimness of 
sight) is frequently produced by the use of considerable doses kept 
up for some time. In actually toxic (poisonous) doses there is 
intense headache with constriction of the forehead, dimness of 
vision or complete blindness, deafness, delirium or coma, dilated 
pupils, weak, fluttering pulse, irregular, and shallow respiration, 
convulsions, and finally collapse and death." It is exceedingly 
rare to encounter such severe cerebral symptoms, however. 

The preparations of cinchona are much used as stomachic 
tonics. In atonic (from weakness) dyspepsia they are employed, 
like the simple bitters, to promote the flow of gastric juice. In 
gastric catarrh they relieve that morbid state of the mucous 
membrane on which the increased production of mucus depends. 
For these purposes the) 7 may be combined with the mineral acids. 
The best preparation is the infusion ; the decoction, although 
officinal, is inelegant and faulty. The alkaloid quinine is 
frequently used for the same purposes, and notably in the gastric 
catarrh of drunkards, combined with acids. In these stomach 
disorders other and less expensive drugs like the compound tincture 
of gentian, tincture of quassia and tincture of columba, may 
be used and to better advantage. 

The reader should be reminded that the preparations of 
cinchona are contra-indicated in all acute inflammatory states of 
the intestinal mucous membrane. Furthermore, if too long 
continued, they will set up an irritation, and perpetuate the 
troubles which they were prescribed to remove. 

There can be no doubt in regard to the power of quinine to 
arrest the inflammatory process in its formative stages in numerous 
affections ; and tonsillitis, inflamed breasts, pneumonia, pleurisy, 
etc. , may often be suppressed by a full dose (20 to 40 grains) when 
given at the commencement. 



90 MATERIA MEDIC A AND THERAPEUTICS. 

In septic diseases quinine has very important uses. Although 
the observations of Binz, showing the influence of quinine over 
septic processes, may not be applicable to the full extent for which 
he proposes them, but there can be no doubt of the good effects in 
practice of quinine in septi<<zmia, pyemia (that is blood poisoning 
from the absorption of pus, or like septic matter), erysipelas or 
puerperal fever, etc. In these diseases, only large doses 5 to 20 
grains every four hours are useful. 

It is a valuable tonic in erysipelas and pneumonia as well as 
in small-pox, scarlatina, typhoid fever, measles, etc., whenever 
sustaining treatment is indicated. One of the principal uses of 
quinine is in the cure of the periodical fevers — intermittent or 
fever and ague, and remittent fever. It is invaluable for fever and 
ague, when combined with Fowler's solution of arsenic. It is 
very largely and successfully employed by the author for this 
purpose in the following prescription : 
R 

Sulphate of Cinchonidia, 1 ounce. 

Aromatic Sulphuric Acid, ^2 ounce. 

Water, 1 pint. 

Fowler's Solution of Arsenic, 6 drachms. 
M. Take a tablespoonful five times a day, as follows : before 
<each meal, and in the middle of the forenoon and afternoon. 
When the chills cease take only three tablespoonfuls a day, one 
before each meal. After the whole mixture has been taken, a 
preparation of iron should follow, to insure against the recurrence 
of the chills. Like in the following formula : 
R 

Ammoniated Citrate of Iron, 4 drachms. 
Fowler's Solution of Arsenic, 2 drachms. 
Water, 4 ounces. 

M. A teaspoonful to be taken after each meal until the 
entire mixture is taken. 

The mode of using quinine for the cure of intermittent fever 
may be formulated as follows : 

The antipyretic is nearly equally effective whether admin- 
istered in the interval or during the seizure. 



MATERIA MEDIC A AND THERAPEUTICS. 91 

If time is an element of importance, no delay is necessary in 
order, to give the remedy in the stage of apyrexia. 

To save the suffering and exhaustion of the febrile movement, 
the attack should be anticipated, and, if possible, prevented. 

As the maximum effect of the quinine is attained in about 
five hours after being taken, it should be administered this period 
of time, at least, before the expected paroxysm. 

As the elimination of quinine takes place with considerable 
rapidity, the maximum curative effect is obtained by the 
administration of the whole amount required in a single dose, 
rather than by a succession of small doses. (Essay). 

The unpleasant cerebral effects of quinine are lessened or 
prevented by the simultaneous administration of diluted hydro- 
bromic acid. 



CHAPTER X. 
Gexito-Urinary Tract. 

Woman's Woes — Menstruation. The Proper Time for the Menses. The "Change of" 
Life " or Menopause. Causes and Utility of Menstruation. The Bible and the Mosaic 
Law on the Subject. The Source of the Menstrual Fluid. Disorders of Menstruation 
— Headache, Absence of Menstruation, Painful and Excessive Menstruation. Advice 
to Mothers in Regard to their Daughter's First Menstruation. The Causes for the 
Non-appearance or Cessation of the Menses. The Use of Female Pills. Chlorosis or- 
Green-Sickness in Young Girls— Its Causes and Treatment. Sitz or Hip Baths and. 
how to tike them. How to Relieve Painful Menstruation. Vicarious Menstruation 
and its Treatment. 

Of the many misfortunes that women have to bear, none 
causes so much complaint, as the regular monthly ordeal, through 
which the}' have to pass at the time of menstruation. Many 
women look forward to this time with dread, and it is a constant 
menace to their peace of mind. No wonder the old philosopher 
used to exclaim, " Thank God, I am not a woman." 

What are the menses f Every twenty-eight days or lunar 
month each healthy woman has what she usually calls her 
' ' courses. ' ' This consists of a discharge from the womb of a muco- 
sanguineous ( blood}-) fluid, varying in amount in different women, 
lasting usually from two to four days. This flow is known to 
physicians as Menstruation or Catamenia, but most women speak 
of it as their ' ' monthlies, " ' ' periods, " " menses, " " courses, ' ' or 
' ' flows. ' ' In temperate regions healthy girls begin to menstruate 
at about the twelfth to the sixteenth year and the flow should 
occur regularly every twenty-eight days, to the time of the meno- 
pause, at from forty to forty-five years. This is the ' ' change of 
life," or the time at which menstruation ceases. In reference as 
to when a young girl should menstruate, it is too often the belief 
that when a girl has arrived at the age of twelve or fourteen years, 
and especially if there is some mammary development, she should 



GENITOURINARY TRACT. 93 

promptly menstruate ; but while the development of the mammas 
or breasts are a good criterion that the womb and ovaries, the 
chief organs of reproduction are present, it is not the only and 
certain reason why menstruation should then begin, there are 
other physiological circumstances necessary to this function — like 
the strength and development of the body in general, a sufficiency 
of blood iii the system, etc. 

THE CAUSES OF MENSTRUATION. 

The most eminent phj'siologists are not in accord regarding 
causes and utility of menstruation. It is a singular fact that in 
the whole animal kingdom womankind is the only animal that are 
subject to this flow with any regularity. The females, of a few of 
the lower animals have indications of this function, but in none is 
it marked. In old superstitious and biblical days it was thought 
that women, through the sins of Eve, had need of purification, and 
that this secretion was given to them as a purifying process ; hence 
during the flow and for a certain number of days thereafter they 
were considered ' ' unclean ' ' and the old Mosaic law had stringent 
regulations on the subject. 

In recent days it has been explained and most eminent physi- 
ologists have agreed, that every twenty-eight days the ovaries 
develop generally one, (sometimes two or more), mature, ripe 
ova, which are fit for impregnation, and that at these periods the 
whole pelvic region is subject to a congestion or overflow of blood 
caused b} T the initiation and excitement of the ovum pressing on 
the tissue of the ovaries, and that finally this ovum is discharged 
through the fallopian tubes into the uterus accompanied by a flow 
of blood from the ovaries and perhaps from the lining membrane 
of the womb, thus relieving the congestion. Women can usually 
predict a few days ahead that their menses are about to appear by 
a feeling of fullness in the abdomen, etc. 

DISORDERS OF MENSTRUATION. 

The function of menstruation being a natural one should be 
devoid of all pain and suffering, but unfortunately such is rathei 



94 GENITOURINARY TRACT. 

the exception than the rule. So commonly is it accompanied by 
annoying disorders, such as headache, or pain in the small of the 
back and groins, that women in speaking of menstruation usually 
refer to it as " being unwell. ' ' They expect to be sick at this 
time, and unless the disorders are severe the} T generally bear their 
suffering with fortitude and in silence, not even consulting a phy- 
sician, deeming it a matter of necessity. There are, however, a 
number of disorders of menstruation so severe as to be constantly 
brought to the physician's attention, and so frequent as to form a 
large part of the practice of plrysicians who make a specialty of 
diseases of women, they are usually classed under the following 
three general heads : 

Amenorrhcea : — Absence of menstruation. Dysmenorrhcea :■ 
— Painful menstruation. Menorrhagia : — Excessive menstruation.. 



AMENORRHCEA. 

This condition is divided into two distinct classes : i. Absent 
menstruation, in girls that have never menstruated ; and 2. Sup- 
pressed menstruation > where the flow, after having been established,, 
ceases to appear at its regular time. 

ABSENCE OF MENSTRUATION. 

Physicians should advise mothers to carefully watch over and. 
consult their daughters during the fourteenth and fifteenth years, 
instructing them regarding the nature of the menses and what they 
may expect. Frequently young girls undergo much mental worry 
on the appearance of their first menses, not having been informed 
that it is a healthy function. They are mortified or frightened at 
such an unusual phenomenon, looking on it as some terrible dis- 
ease, and yet are too modest to speak of their trouble. If the 
menses do not appear when the girl is of proper age she should be 
carefully guarded to see that her health does not suffer in conse- 
quence. Non-appearance of the menses may be due : First, to 
inactive conditions of the generative organs. Second, as a result 
of an anaemic condition of the system. Third, very rarely, to- 



GENITOURINARY TRACT. 95- 

malformation of the organs. In the first case the girl has reached 
the menstrual period, but the menses do not appear. Her general 
health is good but she feels periodically an aching sensation in the 
groins, and the small of the back ; is subject to severe throbbing 
headaches and depression of spirits, languor, uneasiness, and 
usually derangements of the stomach and bowels. In these cases 
the treatment should be mostly hygienic. The patient should take 
plenty of out door exercise, such as walks in the open air, and fresh 
air rides if possible, dancing, etc. The bowels should be kept 
open by mild laxatives. To promote activity of the generative 
organs, the writer would suggest a course of mild tonics, of bitters 
and iron, and to stimulate the pelvic organs in general a Hooper's 
Female Pill (which can be obtained at any drug-store) should be 
given on going to bed, for a week previous to the period that the 
symptoms before mentioned are expected. In this connection it 
is proper to state that only evil can result from the use of direct 
emmenagogues (medicines producing a flow of the menses) when 
amenorrhcea is due to phthisis (consumption). The cessation of 
the regular menstrual flow in such cases is conversative and should 
not suffer interference, but tonics which are always the safest 
emmenagogues can be administered. Care should always be 
observed during the menstrual periods in regard to proper and 
sufficient clothing. The feet should be kept dry and warm. Like 
care should be taken in regard to drinking excessively of water 
or too cold water, inasmuch as there is danger of checking 
the discharge and thus la}dng the foundation for various serious, 
womb trouble. 



chlorosis. 

Non-appearance of the menses is frequently the result of a. 
disease of the general system, called chlorosis or ' ' green sickness," 
being peculiar to young girls about the age of twelve to sixteen 
year,s the period at which they begin to menstruate. It is owing 
to anaemia, the result of deficient nutrition, either from insufficient 
or innutritious food, or more commonly from disorders of the 
stomach or assimilative system. It is characterized by a deficiency 



96 GENITOURINARY TRACT. 

of the red corpuscles in the blood or by a perversion of the 
qualit}^ of the blood itself. Girls afflicted by this disease can often 
be singled out by their yellow, sallow complexion ; they are 
languid, easily fatigued, usually melancholic. Generally, they 
have a poor appetite, and eat but little, and the bowels are usually 
constipated ; the menses do not appear and they are subject to 
•severe periodical headache. Obviously it is useless to try to 
establish the menses until the blood and digestive derangements 
are first corrected, although some physicians undoubtedly err in 
supposing that the derangements of the general health are due to 
absence of the menses, and their endeavors are directed to 
establish the menstrual flow b}- administering active uterine 
excitants. Such a course can only be attended with disastrous 
results. The patient should be surrounded with favorable 
"hygienic conditions such as open air exercise, plain nutritious 
diet, regular hours for sleep, absence of corsets. She should be 
induced to exercise every day regularly in dry air even if it be 
against her inclination. She should walk in the open air, ride, 
(especially on horse-back) ,row, or take an} T other moderate exercise 
according to her abilities. Sitz or hip baths should be used. (In 
several places in this book Sitz baths are advised. A Sitz bath is 
another name for a hip bath ; it ma} r be either hot or cold, but 
whenever referred to here, hot Sitz baths alone are intended). 
An}^ ordinary tub or vessel in which the patient can sit will answer 
the purpose. The water should be heated as hot as can be borne. 
The temperature of the room must be warm so that there is no chill 
in the air and the patient should sit in the hot water from ten 
minutes to a quarter of an hour. She should then be rubbed dry 
with a rough towel. It is well to take Sitz baths before retiring 
at night, if taken during the day the patient should lie in bed, 
well covered up, for an hour after the bath.) The food must be 
nutritious but eas}^ of digestion. To increase the blood and 
improve the general health, iron in some form especially the pill 
of the carbonate, or Bland's pills, bitter tonics, and if there is con- 
stipation aloes, the latter in the form of Hooper's Female pills 
should all be given. Under this treatment the general health of 
the young girl will soon improve and the menses become established. 



GENITOURINARY TRACT. 97 

DYSMENORRHEA. 

Many women never pass the menstrual period without pain 
more or less distressing. When these pains are slight and of 
short duration, they usually do not cause uneasiness and are not 
brought to the physician's attention. When severe, the condition 
is termed dysmenorrhoea , signifying painful or obstructed men- 
struation. The most usual severe form of this disease is 
neuralgic, and usually occurs in women of a nervous temperament. 
It may also be caused by displacement or congestion of the womb. 
When the physician is called during these attacks his efforts should 
be directed to temporary alleviation of the pain. Relax the 
system by means of hot hip or foot baths and administer anodynes 
like laudanum and ether or morphine, preferably the latter, 
administered hypodermatically. A hot fomentation of hops 
should be made by boiling a handful of fresh hops in a quart of 
water, saturating and squeezing from this flannel cloths, placing 
them on the patient as hot as can be borne. Applying these 
fomentations over the womb will often give temporary relief. 
Between the menstrual periods efforts should be made to prevent 
a recurrence of the disease. The patient should be directed to 
take weekly a hot Sitz-bath, and two or three during the few 
da3 T s just previous to the expected period. In addition, to 
promote a free flow of the menstrual fluid, the following emmena- 
gogue pill, one to be taken before meals, for a week before 
the expected time, is beneficial, namely : 
R 

Krgotine, i gr„ 

Fer. Sulph. Kxsic., i gr, 

Ext. Hellebore Nig., i gr„ 

Aloes Soc. , i gr, 

01. Savine, j£ m. 

Which can be obtained, ready-made at any apothecary store. 
If these means fail, the painful menstruation must be caused by 
some displacement or congested state of the womb, then the 
sufferer should place herself under the care and treatment of the 
most skilled physician, who makes a specialty of diseases of 
women. 



98 gexito-urixary tract. 

Menorrhagia . 

Menorrhagia is a profuse or excessive menstruation, and may 
in fact, constitute uterine hemorrhage. The causes of this 
disorder of menstruation are numerous and varied. The same 
name applies to too frequent menstruation. Among the causes 
of this disorder of menstruation may be laceration of the neck of 
the womb, vegetations of the lining mucous membrane of the 
womb, cancer and fibroid tumors. The excessive loss of blood 
ma}' so deplete and weaken a woman that her condition becomes 
precarious from the loss of blood, aside from the very annoying 
features of inability to attend to her domestic duties or enjoy the 
pleasures of society as to mar her happiness greatly and make 
life burdensome, and attention to the matter becomes imperative. 
The hygienic and dietetic measures are important factors 
in this affection. The woman should remain as quiet as possible 
during these flows, perhaps assume the recumbent position. 
Abstain from all stimulating and hot drinks ; eat substantial 
and easily digested food, avoid all excitement, and refrain from 
lifting or elevating the arms above the head as much as 
possible. 

Where this disorder is brought on by vegetations or perhaps 
b} T a small portion of retained placenta after confinement or 
abortion, the proper treatment consists in curetting or scraping 
the internal lining of the womb by means of a blunt curette ; any 
physician of ordinary intelligence can perform the operation it 
being unattended with pain or danger. 

Intra-uterine injections of a weak solution of nitrate of silver 
(lunar caustic), or other astringents may likewise accomplish good 
results. The excessive hemorrhage may also proceed from the 
•ovaries and in that event can readily be cured by large doses of 
bromide of potassium. The fluid extract of ergot, gallic acid, 
powdered opium and acetate of lead ; Monsell's iron or the 
tincture per sulphate of iron, are all capital remedies in this 
affection. Astringent injections per vagina are also of great 
utility. 

During the intervals iron and bitter tonics will most generally 
be required. 



GENITOURINARY TRACT. 90 

VICARIOUS MENSTRUATION. 

By vicarious menstruation is meant when the menses become 
suppressed from some cause or other and the periodical flow is 
discharged from another part than the genital canal. It may 
thus take place from the nose, throat, ears, the rectum, an ulcer 
or elsewhere. This trouble can generally be readily corrected or 
cured by attention to hygienic and dietetic measures in conjunction 
with tonics and laxatives. 



CHAPTER XI. 
Genito-urinary Tract. 

Leucorrhcea or the " Whites." Its Causes, Source and Evil Consequences. Backache. Loss 
of Appetite, and General Exhaustion Sure to Follow its Neglect. Leucorrhcea often 
the Cause of Inducing Gonorrhoea in the Male. A Frequent Factor of Domestic 
Unhappiness and Misery. Catarrh of the Womb as a Cause of Leucorrhcea. 
Successful Home Treatment. Leucorrhcea in Children— Its Origin, History and 
Infallible Treatment. 

Leucorrhcea, " fluor albus " or the " whites " is a discharge 
of a whitish , more or less viscid liquid from the mucous membrane 
of the vagina and uterine cavity w T hich may be profuse, or scanty 
in quantity, and be continuous or only precede the menses a short 
time or perhaps immediately follow the same for a few days, and 
the woman may be quite free from the affection during the inter- 
vals. ' ' In such instances it is dependent on a slight congested 
state of the uterus merely, and needs no further treatment other 
than cleanliness and mild injections, but when it is very profuse, 
aggravated, constant and perhaps somewhat of a purulent nature,, 
and fetid, it is very exhausting and debilitating to an}- woman 
and demands the most careful attention, and very judicious con- 
stitutional and local treatment. Leucorrhcea, strictly speaking, is 
not a disease of itself, but merely symptomatic of some disorder or 
derangement of the uterus or its appendages. But its existence 
for am T length of time if neglected, is sure to be followed by a 
derangement of the system in general. A train of symptoms 
accompany this disorder like paleness, pain, sometimes intense, in 
the back, legs and loins, impaired appetite, chilliness, with general 
exhaustion are sure to follow, and if long continued these symptoms 
will be greatly aggravated, with weight in the loins and lower 
part of the abdomen, great lassitude, often pain in the stomach, 
sour eructations, headache, and in extreme cases dizziness, palpi- 



GENITOURINARY TRACT. 101 

tation of the heart, excessiYe coldness of the feet, and despondency. 
Leucorrhcea is a source of great discomfort, inconvenience and 
annoyance to any woman of cleanly habits, aside from the dis- 
pleasure it will so often occasion to a loving husband, and while 
it is so frequently a fruitful source of inducing gonorrhoea in the 
male, thus causing unhappiness and misery which often leads to 
strife and perhaps separation. The writer would most urgently 
enjoin upon all thus afflicted to avail themselves of every means 
offered them, in order to become cured of this troublesome disorder. 

Causes. — Among the numerous causes of leucorrhcea may be 
mentioned, ulceration of the mouth of the womb ; chronic inflam- 
mation, perhaps of a catarrhal nature, of the mucous membrane 
lining the internal surface of the womb ; the various displace- 
ments of the bod}- of the womb, like prolapsus, versions and 
flexions of the organ ; congestion of the parts, etc. It may also 
be due to a weakened or debilitated state of these organs. Neglected 
or imperfectly treated gonorrhoea of the womb may leave a gleety 
discharge, either of the womb or the vagina or both, which may 
exist for years, unless properly attended to. Leucorrhoea may be 
limited to the vagina and depend upon an inflammation of this tract 
alone. This form admits of ready cure under a course of proper 
injections. The most frequent source of this affection is indiscre- 
tion, by exposure and errors of life during menstruation, and 
improper or injudicious sexual intercourse. Mothers should 
enjoin upon their daughters to observe the laws of hygiene in 
regard to exposure to dampness and cold, diet, and scrupulous 
cleanliness, instructing them to use the utmost care as to keeping 
the feet warm and dry during the menstrual period especially, and 
avoid sitting on damp places ; and to guard against certain moral 
emotions which also require regulation, if the female would escape 
this distressing affection — the mind must be kept pure and free 
from improper associations. 

Treatment. — To be effective the treatment of leucorrhoea must 
be directed to the cause of the disorder, and if you succeed to 
remove that, the discharge will cease likewise. If the complaint 
has existed for any length of time and the system, in general 
weakened or depraved, tonics must be administered to invigorate 



102 GENITOURINARY TRACT. 

and strengthen the system. In such cases iron, quinine in tonic 
doses, the vegetable bitters, cod-liver oil or the compound syrup 
of the hypophosphites are the chief internal remedies. Alum is 
a cheap and useful injection, it may be combined with sulphate of 
zinc (white vitriol) and borax ; the subnitrate of bismuth sus- 
pended by mucilage is an excellent injection, but is costly ; com- 
bined with the fluid extract of hydrastis its value is enhanced. 
Tannic acid or infusion of white oak bark is an excellent application, 
but stains clothing. Carbolic acid with equal parts of glycerine 
diluted aud used with care is a good deodorizer when the discharges 
are foul. A few drops may also be combined with the preceding 
injections. The tincture of per- sulphate of iron is perhaps the 
most valuable injection of all but as it stains the clothing it must 
be used with care. The following preparation has been largely 
employed by the writer with the greatest success and the happiest 
results, as an injection in this complaint, namely : 
R 

White Vitriol, 

Sugar Lead, of each one ounce. 

Rain Water, i pint. 
Mix. 

After a thorough injection with luke-warm water, take a 
teaspoonful of this mixture with half a pint of water and inject 
into the vagina, keeping the legs together so that the whole of 
the mixture is retained for a few minutes ; use once a day. The 
same injection w T ill also cure any gonorrhoea if used in time. Intra- 
uterine injections of peroxide of hydrogen, nitrate of silver 
solution, etc., must always be made by a skilled physician and in 
aggravated cases I would advise the sufferer to avail herself of 
such facilities ; as a good physician can readily improve her 
condition and perfect a cure. 

[Note. Infantile Lencorrhoea. — Children of all ages are 
liable to suffer from a discharge from the mucous glands of the 
vulva. Occasionally the disease spreads up the vaginal canal ; 
giving rise to a profuse purulent or muco-purulent fetid discharge, 
with heat and pain during micturition and excoriation of the 
surrounding parts. Care must be taken not to mistake this 



GENITOURINARY TRACT. 103 

disease for gonorrhoea produced by infection, though I am unable 
to point out an>^ diagnostic signs by which the error may be 
avoided ; for I have seen instances where the inflammation has 
been so intense that the appearance has very much resembled that 
caused by violence, and 3 T et it has been impossible for anything of 
the kind to have taken place. The history must be therefore 
thoroughly inquired into, and the cause surmised. The nature of 
the child's constitution will sometimes throw light on the nature of 
the discharge, inasmuch as strumous subjects are especially apt to 
be affected with leucorrhoea, particularly during the period of 
teething, or if they suffer from neglect of cleanliness, or from 
the irritation of threadworms or pinworms in the rectum, or from 
constitutional debility. Occasionally the discharge seems to 
prevail as an epidemic. The virus is higly contagious, and its 
application to the eyes gives, rise to violent inflammation of 
these organs. It has been doubted whether the discharge is 
communicable from the child to the adult male or female ; for 
unfortunately cases of infantile leucorrhoea have led to false 
accusations and much misery. The treatment of infantile 
leucorrhoea must be perseveringly carried out, or he disease will 
last for months. Attention to cleanliness, frequent sponging 
w T ith an astringent, (like the above, but much weaker), the 
use of cold hip baths containing a little alum, and mild 
alteratives or laxatives will be needed. The diet should be plain 
but nourishing ; and tonics — especially of quinine and iron 
will always be useful.] 



CHAPTER XII. 
Genitourinary tract. 

Gonorrhoea in the Male, its Cause, Origin and History. Women Frequently Give Gonor- 
rhoea without Having the Disease Themselves— through Deucorrheea. Professors 
Taylor and Bumstead on the Subject. Safeguards Against Gonorrhoea. The Great 
Need of Cleanliness — Symptoms — Treatment. Danger Resulting from Improper or 
Very Strong Injections. Serious Consequences from the Excessive Employment of 
Copaiba. Many Invaluable Receipts. — Complications — Sequela — Inflamed Eyes — 
Swelled Testicles — Buboes— Strictures, etc. 

Gonorrhoea, from the Greek gone, semen, and rheein, to flow, 
(because erroneously supposed to cpnsist of a flowing off of semen) , 
may be denned as an inflammation of the urethra in the male and 
of the vagina, vulva, urethra or uterus in the female, depending 
upon some local irritation for its development, the most common 
cause being contact during sexual intercourse with purulent or 
disordered secretions from the genito-urina^ tract. Gonorrhoea 
has its origin in the remote ages and the reference to ' ' the unclean- 
ness of men in their issue," in the XVth chapter of Leviticus, 
most probably refers to the disease. According to Astrue, the 
disease did not appear until 1545, and this reference of the Bible 
was to what is known as urethritis (inflammation of the urethra 
— the passage which leads from the bladder) . The disease has 
been known under various names but in Medicine the word gon- 
orrhoea is very generally employed, though etymoiogically, the 
term is incorrect. Some medical writers have endeavored to sub- 
stitute for the name, the word Blennorhagia, coined for the purpose, 
but the new name has never come into general use. The old 
Saxon word " clap," which is still the vulgar and popular name 
has been tabooed by most medical writers. 

In late years the advance of microscopic investigation has 
shown that the pus and pus-cells, discharged in the mucus of gon- 
orrhoea contain a vegetable product called, " Gonococcus," by 
their discoverer, Neisser. Some writers state that only mucus 



GENITOURINARY TRACT. 105 

-containing these peculiar gonococci are the cause of the disease. 
It is, however, claimed by other writers that these gonococci are 
the result, not the cause of the disease, and that they can only live 
on mucous membranes afflicted by it. 

Two of the most important questions in the study of gon- 
orrhoea are its cause and origin. So much often depends upon a 
clear understanding of how a given case of gonorrhoea originated 
that an explicit exposition of the subject is demanded. Gon- 
orrhoea in a male is sometimes derived from a female thus suffering, 
but such cases are much less numerous than those in which it 
arises from other sources. Ricord's proposition, that ''women 
frequently give gonorrhoea without having it themselves,' 1 '' may, I 
think, be unreservedly accepted as an axiom, and its importance 
cannot be over-estimated. Of it Fournier says : "The result of 
my investigation convinces me that the opinion of Ricord is the 
only one which can be accepted as conforming to the facts of daily 
observation. ' ' It seems to me, however, that it falls below the truth. 
In my opinion he should have said ' most frequently. ' Fournier 
further thinks that to one case in which gonorrhoea originates in 
gonorrhceal pus, there are three which have a different origin. 
Dr. Robt. Taylor, Professor of Dermatology, at the New York 
Post Graduate Medical School, in his excellent work entitled 
: ' Venereal and Skin Diseases," says : " Of thirty men affected 
with true gonorrhoea, in but five did I find gonorrhoea in the 
women with whom they had cohabited. ' ' 

By far the majority of cases of this disease originate in coitus 
with a woman suffering from some form of purulent discharge 
from the genital tract. A consideration of the frequency of these 
discharges in the female explains the great frequency of gon- 
orrhoea in the male. The gonorrhoea which originates in these 
discharges may be mild in character or of great severity and 
•obstinacy. 

Coitus (sexual intercourse) just before, during, and after 
.menstruation is very frequently followed by gonorrhoea, which is 
usually of a severe type. Many authors speak of the severity of 
the affection thus acquired, and Diday dignifies it by the name 
"" urethrorrhoea," (simply a flow from the urethra). Certain it 



106 GENITOURINARY TRACT, 

is that the course of such a gonorrhoea may be as severe and pro- 
tracted as it is when it originates from acute gonorrhoeal pus. In. 
this manner mam 7 husbands who have for }^ears cohabited with, 
their wives with impunity have contracted the disease, and the- 
same often occurs in the unmarried. 

Gonorrhoea sometimes occurs under peculiar circumstances, 
which are clearly given by Prof. Bumstead, of New York, who 
says : "I am constantly meeting with cases in which one or more 
men have cohabited with impunity with a woman, both before and 
after the time when she has occasioned gonorrhoea in another 
person, or less frequently in which the same man, after visiting a. 
woman for a long period with safety, is attacked with gonorrhoea 
without any disease appearing in her, and after recovery resumes 
his intercourse with her and experiences no further trouble. The 
frequency of such cases leaves no doubt in my mind that 
gonorrhoea is often due to accidental causes and not to direct 
contagion. ' ' 

' ' Though husbands somewhat exceptionally contract gonor- 
rhoea from wives free from the disease, in the vast majority of 
cases, however, their partners suffer from uterine and vaginal 
discharges, which they escape. The same is often true as to the 
lover and mistress. The most rational explanation of this 
immunity of the males is that frequent exposure to the irritant, 
secretions has produced what the French term acclimation. Thus 
it is that with married women, and in unsanctified cohabitation the 
favored, but luckless lover, often comes to grief for the want of 
this indefinite, though none the less real, factor in the case, viz : 
acclimation. A clear and positive statement of this fact will often 
spare an innocent person the suspicion or accusation of having 
gonorrhoea and of communicating it. " Professor Ta}dor in his 
clinical lectures illustrates the baneful effect of the theory that 
gonorrhoea is always due to a specific virus by the details of one 
of the many sad cases which have come under his observation.. 
One of these cases is as follows : "A married man, twenty-six 
years old, returned after a month's absence and cohabited with 
his wife. In two days he noticed the usual symptoms of acute 
gonorrhoea, and consulted a plrysician, who informed him he was 



GENITOURINARY TRACT. 107 

suffering from that disease. To the patient, being incredulous, 
the physician fortified his position by quoting from the work of a 
prominent author from whose teachings he had gained his belief. 
Such was the patient's anger and disgust that he immediately 
confronted his wife, who was at the full table of a large boarding 
house, and in vile and blasphemous language accused her of 
infidelity and of giving him a foul disease. Amid shame and 
distress of mind the wife indignantly spurned the charge, but to 
no effect. The husband left the house and went elsewhere, but 
took occasion to inform his wife's relatives of the state of affairs. 
At this time a second visit to the physician resulted in a more 
positive asseveration of his opinion. Such was the desperate 
state of affairs that 'the husband consulted a lawyer with a view 
of getting a divorce. At this juncture the wife's brother insisted 
that her husband should accompany her to my office, with the 
view of settling the matter. It was a memorable interview with 
the sullen and angry husband and the indignant and outraged 
wife. The husband's first question was, " Could a man contract 
gonorrhoea from a wife who was not so affected ?' ' To which I 
replied emphatically, ' ' Yes. ' ' I then went over with him the various 
sources of origin of gonorrhoea, and instanced cases which I had 
met in which groundless suspicions had been entertained between 
husband and wife. When I came to inquire into the circum- 
stances of his case, I learned that his wife had sometime previously 
been the subject of an operation upon the uterus, and that she 
suffered from leucorrhoea. This was sufficient to clear her of all 
suspicion ; but when I mentioned the fact that the menstrual 
fluid sometimes caused severe gonorrhoea, the wife eagerly and 
triumphantly said to him that he had forced her on that night to 
intercourse in spite of her waning menstruation. The husband 
was chagrined and humiliated. Later on, domestic happiness 
was restored. ' ' 

A still sadder case was published in an old French work on 
venereal diseases: "A young man, after having lived with a 
young girl for some years, married her. Some months after he 
was compelled to take a journey of some distance, and while 
travelling was attacked with gonorrhoea. He consulted a phy- 



108 GENITOURINARY TRACT. 

sician, and informed him that he had never had connection with 
any woman but nis wife. The physician laughed and made a 
sarcastic reply. Some days after, when the testicle swelled, the 
latter informed him that if his wife was virtuous he must have 
had ' ' une affaire ' ' (sexual intercourse) with other women. The 
young man wrote to his wife an indignant and passionate letter 
and then blew out his brains. The unfortunate woman, who was 
found to be free from disease, miscarried and died." 

Fournier tritely remarks that a man gives himself the 
gonorrhoea oftener than he receives it. Professor Taylor says that 
this is true and remarks : ' ' We very frequently see married and 
unmarried men with an urethral discharge which, originates in 
some old and latent lesions of some portions of the urethra, which 
under certain conditions, have become inflamed. These lesions 
may be of a trifling or severe character, such as local thickening, 
a slight stenosis (narrowing) of the canal, stricture, granulations, 
and polypoid growths. It can be readily understood that men 
with urethrse thus damaged, are prone, the proper cause existing, 
to gonorrhoea, whether or not the females are suffering from a 
discharge. These causes are sexual excess, high living, the 
abuse of stimulants, prolonged horse-back riding, etc. 

Though it has been claimed that intense and prolonged sexual 
excitement without completion of the act has been followed by 
gonorrhoea, it is rational to suppose that in such a case there was 
pre- existent damage to the urethra. 

Gonorrhoea is one of the few diseases that is much more 
severe in men than women, and male cases are more common, 
owing to the peculiar unwritten moral laws broken by men 
without restraint. The passages affected by the disease in woman 
are of larger size, the urethra (when it is affected) is much 
shorter, hence the disease does not inconvenience and aggravate 
the female as it does the male patient. In addition, the parts 
affected are much more within the reach of the physician's treat- 
ment, for with women astringent injections, which cure the disease 
so readily, can be made without danger of stricture, etc., which is 
not the case with men. Notwithstanding the ease with which it 
can be cured in women, many dissolute women who contracted it, 



GENITOURINARY TRACT. 109 

suffer it to run on for months and thus become its prolific distri- 
butors. The fact that it gives women, as a rule, so little pain 
and trouble, explains the reason why they so frequently allow 
the disease to run on, or fail to avail themselves of proper and 
timely treatment. The writer embraces this opportunity to 
exhort all women thus afflicted to become clean and cured of this 
loathsome disease, as it may entail endless woe and misery upon 
others than themselves. This also applies to those who are 
suffering from leucorrhceal discharges. As prevention is always 
better than cure, I would urgently recommend all women to 
supply themselves with good family syringes, or what is still 
better, if means afford, a douche-bag holding at least, three 
quarts of water, which can be obtained of the writer. It is well 
to use a douche often, especially just after the menstrual period, 
as nothing can be so conducive to cleanliness and thereby to good 
health than this. I would also especially recommend as a prophy- 
lactic (preventive) against the contagion of gonorrhoea that the 
person having unsanctioned sexual intercourse, use immediately 
ablutions of warm water after coitus. Urination practiced at the 
same time likewise assists in removing from the urethra whatever 
discharges, may be present, and thus lessen the liability of con- 
tracting the disease. (This applies especially to males. ) 

Gonorhoea manifests itself to the male patient in five or 
seven days after the exposure or impure contact. In exceptional 
cases the time is shorter or longer, and good authority states that 
cases are known which develop in from twenty-four hours to 
fourteen days ; however, five to seven days is the usual time. At 
first a slight pricking, teasing sensation is noticed at the orifice 
of the glans penis, which, in the course of a day becomes so 
intense as to be exceedingly unpleasant. The lips of the orifice 
swell and are glued together with a slight viscid secretion. Thus 
far the urethra is dry. The second day a milky white mucous 
discharge appears, at first in small quantity, merely a drop at the 
end of the gland, afterwards more profuse. This discharge 
becomes more abundant, thick, yellow (and in some cases 
greenish), for the period of several days. It dries on the linen 
with a stiff, yellow stain, and is liable to soil both the underwear 



110 GEN ITO -URINARY TRACT. 

of the patient and the bed linen. This discharge is accompanied 
with inflammation of the soft tissue of the penis, which becomes 
much larger than its natural size. After the course of a week, 
the disease will have passed its acute stage and will gradually 
decrease in intensity, whether treated or not. The inflammation 
subsides ; the discharge grows less, and the patient is much 
encouraged and may think he will recover without the aid of 
medicine or treatment. Such, however, is rarely the case. On 
the contrary, the discharge usually continues indefinitely and 
finally becomes chronic and develops into what is called Gleet, 
which has more serious results and is much more difficult to cure 
than the original Gonorrhoea. Gonorrhoea is not a very painful 
disease, and frequently young men express themselves that " The}' 
would as soon have a case as a bad cold." In many instances, 
the only actual pain experienced is in the passage of urine and 
in chordee. 

Treatment. The passage of the acid urine through the 
inflamed gonorrhoeal urethra causes a hot,, scalding pain, so that 
to the gonorrhoeal patient passing water is usually a severe 
ordeal. It can be mitigated by the administration of mild alkalies 
internally, such as half a teaspoonful of common baking soda 
dissolved in water and drunk before each meal. The patient's 
urine should then be tested with litmus paper until it becomes 
nearly neutral, when the soda should be discontinued. 

Chordee or painful erection of the penis is said to be the 
most painful sensation connected with the disease. It is not 
present in all cases ; some afflicted persons have it often and 
severely, others rarely and mildly. It is caused by the stretching 
of the inflamed erectile tissue due to the erection of the penis 
during sleep. The pain is sudden and severe, and the patient 
often springs from his bed in sudden parox3 T sms of pain. 
Temporary relief is usually found by inserting the penis in a 
basin of cold water which relaxes the tissue. The pain is apt to 
recur again under the influence of warmth, say as soon as the 
patient has returned to bed and fallen asleep, and this may recur 
several times during the night. Patients should be warned against 
forcibly ' ' breaking the chordee ' ' hy straightening the penis by 



GENITOURINARY TRACT. Ill 

force, as this practice is liable to cause hemorrhage and consequent 
■stricture. A pill of camphor, one grain, and opium one-half 
taken before retiring, or a dose of ten grains or more of bromide 
of potassium will have a tendency to allay this sexual excitement 
and prevent its occurrence. 

It has been said that indirectly gonorrhoea causes more deaths 
than syphilis, not from the disease itself but from injudicious 
treatment, bringing on urethral stricture or some other compli- 
cation. From the nature of the disease, patients are anxious 
to have as speedy a cure as possible, and they importune 
the physician to stop the flow of secretion in a few days. If the 
physician yields to the entreaties of the patient and injects a 
strong astringent, the result is that the flow is checked, but the 
case is usually changed to stricture^ a disease that is much more 
serious than gonorrhoea and excruciatingly painful. Or, perhaps 
the patient does not consult a physician , but surreptitiously injects 
one of the man}' patent articles advertised ' ' to stop the now in 
twenty four hours," which usually results in the most distressing 
termination. Too much care can not be taken in injecting astrin- 
gents in cases of gonorrhoea. When a case of gonorrhoea is pre- 
sented, the patient should first be given a mild laxative, as consti- 
pation, which usually accompanies cases of gonorrhoea, very much 
aggravates the disease. The following prescription is useful. 

R Fluid Extract Cascara Sagrada, i ounce. 

Simple Syrup, i ounce. 

Mix. Dose, a teaspoonful, increased every morning for five 
days, or until the bowels move freely. Then the patient should 
be directed to provide himself with a bag to contain the penis, and 
-prevent the discharge from soiling the clothing and bedding. Bags 
manufactured expressly for the purpose and known as ' < gonorrhoea 
"bags," are sold by druggists, but an excellent substitute can be 
-made by cutting off the toe of an old stocking, which can be 
retained in place by pinning with safety pins to the drawers in such 
•a position as to hold the penis. The bag should be lined with 
absorbent cotton to catch and retain the discharge. Do not close 
the mouth of the penis with cotton, or otherwise, as that is very 
injurious irritating the parts and greatly aggravating the disease. 



112 GENITOURINARY TRACT. 

Nothing ought to be done towards checking the discharge until 
after the acute stages of the disease have passed ; that is, until six: 
or seven days. The canal of the penis should be syringed out, 
however, with warm water as often as three times a day. As the 
patient usually thinks he should be using some medicine, I very- 
often give him the following prescription. 
R 

Subnitrate of Bismuth, y 2 drachm. 

Water, 8 ounces. 

Carbolic Acid, 5 drops. 

Mix. Warm to tepid heat and use as an injection. Shake 
well before using. 

The subnitrate of bismuth has a tendency to coat the folds of 
the canal and to mitigate the disease. It can do no possible harm 
but it must be remembered that the above prescription is not 
intended to stop the flow of mucous but merely to lessen the heat and 
inflammation. The patient is also cautioned regarding the acrid 
and poisonous nature of the discharge and instructed to carefully 
cleanse his hands after handling the parts affected. Trouble can 
readily be prevented by a careful washing ; the mucous being very 
soluble in water. The patient should be particularly warned not 
to rub his eyes with unclean hands, and to see to it that none of 
the mucus be accidentally introduced into the eyes, as it causes a 
most distressing affection of the eyes, called gonorrhoeal conjuncta- 
vitis, which is almost sure, to destroy the sight. 

As has been said, gonorrhoea has a stage of about a week, 
sometimes longer, of acute inflammation, and nothing should be 
done to check the discharge until at least a week after the disease 
has run. Nothing causes as much consequent troubles like swelled. 
testicles, strictures, buboes, etc., as injudicious injections during 
the inflammatory stage. When the discharge begins to lessen, 
when the acute stages are over, then treatment proper should 
begin. It is usualty a very simple matter to stop the discharge of 
gonorrhoea. Any astringent, as sulphate of zinc with acetate of 
lead, or tannic acid, injected even in an acute case of gonorrhoea, 
will surely stop the discharge in a few days and the many mixtures, 
which are usually simple astringent solutions, advertised ' ' to stop 






GENITOURINARY TRACT. 113^ 

the flow in twenty-four hours, ' ' approximate the truth. But the 
injection of an astringent into the canal congested by the disease, 
will, in a majority of cases cause such a sudden contraction of 
the tissue as to rupture it, very slightly, and perhaps unnoticeably,. 
it is true, but still enough to almost invariably result in a stricture. 
A preparation known as Lloyd's hydrastis, though not so quick,, 
gives good results from its use, and is very much employed in 
stopping the discharge. It acts by stimulating the mucous mem- 
brane to the performance of the normal functions, and to throw 
off an}' disease or abnormal condition to which they may be sub- 
jected. For this purpose, the patient after the acute stages have 
passed, should use the following prescription : 
R 

Lloyd's Hydrastis, 4 ounces. 

Aqua (water), 6 ounces. 

Mix. Use as an injection, three or four times a day. 
The prescription is colorless, and is non-irritating. When 
first used, if the parts are tender, the sensation of cold would be 
unpleasant ; hence it is better to warm the solution to a tepid heat, 
(blood temperature), before injecting, but after a few days use, the 
parts will become so much better that it can be injected at ordinary 
temperature without warming and without causing any unpleasant 
feeling at all. 

There is now sold at almost all reliable drug stores, a pill for 
the cure of gonorrhoea called Wyth's sugar-coated compressed 
gonorrhoea pills, the formula of which is as follows : 
R 

Powdered Cubebs, i}( grs. 

Balsam of Copaiba (solid), % gr. 

Ferri Sulph Bxsic. , % gr. 

Turpentine (Venet.), % gr. 

Dose. One pill three or four times a day, which can quite 
safely be taken early in the complaint. 

While the writer would not entirely discard, or reject, the 
use of the balsams as specifics in the treatment of gonorrhoea, he 
nevertheless does not encourage the too excessive, or reckless, 



114 GENITOURINARY TRACT, 

employment of them, especially the balsam of Copaiba, and would 
hereby quote Prof. Robert Bartholow's opinion on the subject : 

"Very serious injury may be done to the gastro-intestinal 
canal, and to the kidneys, by the use of this agent (balsam Copaiba) 
in large doses. The author has known gastro-intestinal catarrh 
to persist many months after a course of copaiba, and he has reason 
to believe that desquamative nephritis and fibroid kidney have 
resulted from its free administration for a lengthened period. 
While small doses of balsam will increase the gross amount of 
urine, and of the solid contents, large doses will actually cause a 
diminution in the amount both of water and solids by setting up 
renal irritation." 

The following mixture will be of advantage in a typical case 
of gonorrhoea : 
R 

Bromide of Potassium, 5ss, (one-half ounce) . 
OilofCubebs, sss, (one-half ounce). 

Oil of Sassafras, gtt xii. (12 drops). 

Syrup of Gum Arabic, gii, (2 ounces). 

Water added, £vi, (6 ounces). 

Desert spoonful every four hours. 

At the same time the injection may be changed to one con- 
taining an insoluble powder, which by coating the urethra and 
partially protecting it from urine, and also by its mechanical 
influence in constricting the dilated vessels by keeping the walls 
separated, often serves greatly to reduce the discharge. The fol- 
lowing formulae are the best among a great many : 
2. R 

Bismuth, (subnitrate) , one drachm. 

Glycerine, two drachms. 

Rosewater, added. four ounces. 



Mix. 
3- » 



Mix. 



Bismuth, (subcarbolate) , one drachm. 

Mucilage of Gum-arabic, one-half ounce. 
Rosewater, three-and-a-half ounces. 



GENITOURINARY TRACT. 11.5 

4. R Zinc, (acetate), one scruph:. 

Tannic Acid, one scruple. 

Rose water, six ounces. 

Mix. 

5. R Sulphate of Zinc, one scruple. 

Sugar of Lead, one-half drachm. 

Laudanum, three drachms. 

Tincture of Catechu, three drachms. 

Water added, six ounces. 
Mix. For injection. 

After the cubeb mixture ( i . ) has been taken for two or three 
days, if the case is progressing favorably, copaiba may be substi- 
tuted or added to it, or, better still, capsules containing 20 drops 
each of oil of cubebs and oil of copaiba may be taken in doses of 
from 2 to 4, three or four times daily. In certain cases, where 
these preparations disagree, or seem to lose their effect, it will be 
well to substitute sandalwood oil, in doses of 10 drops four times 
daily. This amount ma}* be dropped on a lump of sugar, which 
will absorb it, and then may be swallowed and washed down with 
a little water without difficult}*, or it may be taken in capsules. 
The pure sandal oil is perfectly translucent and of a pale amber 
color. These capsules can be obtained at any good drug-store. 

I have had more than ordinary success, with the following 
injection : 

R Sulpho Carbolate of Zinc, 5 grains. 

Water added, 4 ounces. 

The dose, however, may be increased two-fold after a week's 
time. 

Another very valuable injection is the following : 

R Ext. Hydrastis fid. , four drachms. 

ZinciSulph., twelve grains. 

Sulphate of Morphine, two grains. 

Mucilage of Gum-arabic, one ounce. 

Water, four ounces. 

Mix. Inject four or five times a day. 



116 GENITOURINARY TRACT. 

Medical writers and lecturers usually recommend the employ- 
ment of the ordinary sharp pointed male syringe and direct the 
patient to insert its nozzle the full length. This operation is very 
painful, the inside passage of the urethra being very tender to the 
touch. A syringe with a cone point, is much less painful to the 
patient. Such syringes are known to the trade as " cone point " 
syringes and are made both of glass and of rubber. The syringe 
should be of sufficient size to contain about one half ounce of the 
injecting fluid. It should be held with the nozzle firmly to the 
opening of the canal, so that the fluid can not escape outside, then 
the piston being pressed down with the forefinger, the fluid, under 
the pressure, fills every fold of the inflamed passage. The opera- 
tion is not attended with any pain, and affords the patient a feeling: 
of cleanliness and relief. 

The patient should bear in mind that he can aid the physician 
in the cure of his case by a temperate and careful mode of life. 
He should avoid dissipation of all kinds, late hours and exertions 
of an} 7 sort. The use of any alcoholic drink also aggravates the. 
disease, and the patient should, above all, refrain from sexual 
indulgences. Many cases of gonorrhoea are apparently cured, and 
would be cured, in fact, in a few days, but instead are brought on 
anew and given a new lease of life by a single indiscrete action. 
Unless the patient lives an exemplary life, free from dissipation, 
it is almost certain that his case will develop into gleet. Absolute 
acquiescence in these rules should be insisted on, as it will assist 
in accomplishing a speedy cure, 

There are some cases of gonorrhoea that are exceedingly ten- 
acious. A certain physician once said that he would rather treat 
syphilis, than one of these exceptional gonorrhoea cases. With the 
former he knew just what course to pursue, but with the latter, 
each case might require a different remedy. 

Sometimes the patient thinks that he is cured, the discharge 
having ceased. He may still find, however, that violent exercise 
or other indiscretion may bring back the flow. Under these con- 
ditions the facts are that, while most of the urethral tract has been 
restored to its normal state, some local spot remains infected by 
the disease. The small amount of mucous that is formed is. 



GENITO-URINARY TRACT. 117 

cashed away during the day and the patient may know nothing 
of it. 

On rising in the morning, he should squeeze the penis gently 
and if the cure is not complete, a small drop can generally be 
-expelled. 

In these tenacious cases the passage of an instrument called a 
sound, usually effects a permanent cure. Of course this can only 
be done by a physician. 

In some cases after all marked symptoms have vanished, there 
"will yet remain a milky — or, rather, creamy — drop, which can be 
pressed out of the meatus whenever a few hours have elapsed after 
urination ; this is chronic gonorrhoea. The mouth of the penis 
-will often be found a little reddened or swollen, there will be an 
undue warmth or even a slight scalding on urination, erections 
will be accompanied by a dull ache, and all these symptoms will 
be much increased by venereal, alcoholic, or other excesses, espec- 
ially by prolonged and ungratified sexual excitement and by the 
free use of spirituous liquors of inferior quality. There is no 
interval between this condition and the last stage of an acute gon- 
orrhoea, and the use of the sound or bougee will in most cases 
complete a cure. 

Note. — The employment of suppositories in the treatment of 
gonorrhoea is an efficient mode of direct medication. It has the 
advantage over injections in-as-much as it will remain longer in 
•contact with the inflamed urethra. Urethral suppositories of 
extract (solid) of hydrastin and acetate of morphia are excellent 
applications for this purpose. They are to be introduced on going 
to bed and the mouth of the penis kept closed until the suppository 
is melted. 

A DESCRIPTION AND TREATMENT OF COMPLICATIONS. 

The complications of gonorrhoea are quite numerous, but the 
scope of this work will not afford much more than a passing notice 
of them. The technical terms of these affections are employed in 
order that the reader may know how to find a further description 
of the same in surgical works. 

Balanitis is an inflammation of the head of the penis, and 
balano-posthitis constitutes an inflammation of the glans-penis 



118 GENITOURINARY TRACT. 

(head of penis) together with an inflammation of the prepuce 
(foreskin) of the same. Perfect cleanliness and the use of some 
dusting powders like calomel, bismuth, or powdered opium, and 
lycopodium applied three or four times a day, the part being pre- 
viously washed and gently dried, will usually be all that is required. 
Strips of dry lint inserted between the glans and foreskin, and 
changed whenever they become moist from the discharge, will often 
effect a cure. 

I have found very good results from painting a 30% solution 
of nitrate of silver over the inflamed parts. 

Phimosis, or tightening of the foreskin, producing inability 
to replace the same, occasionally results from gonorrhoea. In 
nearly every case lead-water and laudanum applied externally- 
together with injections (under the foreskin) of castile soap and 
water, followed by the injections recommended for the urethra,, 
will reduce the swelling, so that the glans may be uncovered. If 
these means fail, the condition may be relieved by slitting open 
the foreskin along the back of the penis, completing the regular 
operation for phimosis later. Peraphimosis, or the opposite con- 
dition, sometimes occurs ; that is a condition in which the foreskin,., 
after being carried back of the head of the penis, is held there and 
cannot be restored to its proper position. Any intelligent physi- 
cian should be able to replace the parts by manipulation, but if he 
cannot succeed in this way, a small incision must be made on the 
back ot the penis, where the constriction exists, and instantaneous- 
relief will follow. The parts, which are generally greatly enlarged 
by infiltration or inflammation, soon resume their normal condition,, 
aided b}^ cooling lead and opium lotions. 

Epididymites and orchitis, or swelled testicle, is quite common 
in gonorrhoea. It is often very painful but never dangerous and 
will readily yield to the following : 
R 

Tincture of Aconite Root, one ounce. 

Laudanum, one ounce. 

Solution Subacetate of Lead, two ounces. 
Water, two ounces. 

Mix. 



GENITOURINARY TRACT. 119 

Apply continuously, directly over the painful testicle, a piece 
of lint soaked with the solution. When the tunica vaginalis 
becomes distended with fluid, constituting hydrocele, immediate 
relief is afforded by puncturing the sac. Strapping the testicle, by 
means of adhesive plasters after the pain ceases, is also very bene- 
ficial. Tobacco poultice is also highly recommended in swelled 
testicles. A properly constructed suspensory bandage should 
always be worn. Permanent enlargement of the testicle some- 
times results from these inflammatory conditions, and is difficult 
of complete cure. But equal parts of blue ointment and belladonna 
ointment, with the internal administration of some mercurial medi- 
cine, has alwaj's succeeded, in my hands, to completely reduce 
such indurations. 



CHAPTER XIII. 
Genito-urinary Tract. — Gonorrhoea in the Female. 

The Parts Affected. The Taws of Cleanliness Not to be Overlooked— Treatment — Gonor- 
rhoea in "Women is More Quickh- and Easily Cured than in the Male. Constitutional 
or Internal Remedies Seldom Necessary — Infallible Receipts and Directions. 

Gonorrhoea in the female is not as frequent, as limited in its 
situation, as protracted in its course, nor as serious in its results 
as in the male, These facts are fully established by experience, 
and it may affect the vulva, vagina, urethra or uterus with a fre- 
quency indicated b}^ the order of mention. It ma}^ affect only 
one of these parts, or all of them at once. As stated in describing 
gonorrhoea in the male, women are much more subject to chronic 
discharges from the genital parts than men, and the fact that they 
so often neglect their persons in this respect is deplorable, for 
gonorrhoea, which, alas, is so frequent in these times, would be 
almost unknown if the laws of cleanliness were better observed. 
It is almost impossible for a man with an acute urethritis, that is 
in the most contagious stage of the disorder, to have connection, 
the pain produced by erection being in itself a sufficient preventive. 
This is not true of women to anjihiing like the same extent, pros- 
titutes especially often plying their trade in disregard of the com- 
paratively moderate pain of even an acute vaginitis. When the 
vulva is affected the passage of the urine across the inflamed 
surfaces gives rise to an intense burning, which may be mistaken 
for an inflammation of the urethra and is often quite as severe. 

TREATMENT. 

The treatment differs somewhat according to the parts 
affected. To procure a speedy cure the patient should remain in 
bed with absolute rest, especially in cases where the vulva is 



GENITOURINARY TRACT. 121 

effected, as the friction produced by movement operates power- 
fully, and very injuriously, if the person insists upon moving 
about. Perfect cleanliness and dryness of the parts are essentials 
of success in treatment. The labia should be gently washed every 
two hours with a strong solution of bi-carbonate of soda (baking 
soda), which will dissolve and remove all accumulated discharges 
-and will, at the same time, prove to be a very soothing application. 
In using this, the labia should be gently separated with the thumb 
and fingers of one hand, while, with the other, a stream of the 
alkaline solution is squeezed out of a sponge held a short distance 
-above. After this operation is completed, a soft, old linen rag 
should be held in contact with the vulva until all the fluid is 
absorbed, the parts should be dusted with a fine powder of starch 
and oxide of zinc, or of opium and lycopodium, a piece of patent 
lint should be carefully interposed between the labia, and. absolute 
-quiet should be preserved until it is time to repeat the dressing. 
Jn certain cases the inflammation runs so high, the swelling, pain, 
and discharge are so excessive, that these gentle measures do not 
suffice. It will then be necessary to purge, to employ prolonged, 
general hot-baths, not sitz -baths, and then to follow them with a 
lotion of opium and lead water kept continually on the inflamed 
Tegion, or to paint the entire vulva with a forty grain solution of 
nitrate of silver. This last expedient may be adopted earlier, 
-and rarely fails to produce a good effect. When the burning and 
the throbbing are very great, and particularly if there is some 
-constitutional disturbance, the abstraction of blood by leeches 
placed along the line of the groins and on the perineum, is very 
beneficial. The diet, during this period, should be restricted, 
^consisting chiefly of milk and farinaceous articles. 

In cases where the vagina is affected, the routine treatment 
-should be as follows : The patient (usually) being in bed with the 
buttocks resting upon a hair pillow or a folded sheet, the bowels 
having been opened with a saline laxative, should be instructed 
to wash out the vagina every two hours with an injection of a 
pint, or two, of soap and water — or, if that prove irritating, with 
an alkaline solution ; to follow this with a pint of simple water, and 
-to conclude with a pint of some medicated solution, preferably at 



122 GENITOURINARY TRACT. 

this stage, one of acetate of lead. This at first sight seems like 
a tedious and rather formidable procedure, but it is really very 
easy of accomplishment, and requires but a few moments for its 
performance. Before using the injection, the patient may, if she 
chooses, move to a lounge, or preferably to an old blanket spread 
upon the floor. She should employ a Davidson's or Mattson's 
' ' family ' ' syringe, using the long nozzle. This should be greased- 
with a little vaseline, and gently inserted into the vagina to its- 
entire extent, the patient lying on her back with the heels drawn 
up to the buttocks. The rubber tube, to the end of which the 
leaden sinker is attached, should then be dropped into a basin of 
water, in which a piece of white castile soap has been briskly 
stirred, or into one containing two, or three, teaspoonfuls of" 
bi-carbonate of soda in solution. A bed pan, a piece of rubber 
cloth, a large sponge, or, better still, some old muslin or flannel 
rags, being placed beneath the nates (buttocks), so as to catch, 
or absorb, the overflow ; the injection should be given in the: 
usual manner, by regularly compressing the rubber bulb ; after 
which, by a simple transference of the sinker to a basin, or other- 
vessel, of clear water, the soap can be washed out, and the vagina- 
thus prepared for the astringent, or sedative solution, which it is 
thought best to use. This, having been previously prepared in a 
wide-mouthed bottle, or another basin, may be given in the same 
way, and the S3^ringe may then be withdrawn. After a very 
moderate experience the patient will be able to go through with, 
this process in five, or ten, minutes, and with perfect comfort. 
The materials used as injections are various, but belong chiefly to^ 
the classes known as astringents and antiseptics. ' ' In the thera- 
peutic value of the latter in the treatment of vaginitis I have no- 
faith — permanganate of potassium, carbolic acid, Labbaraque's 
solution, and others, having seemed to me to be of no more value,, 
except, possibly, in correcting offensive odors, than as so much 
cold water. ' ' ( Ashurst) . The hot vaginal douche is recommended 
and is sometimes greatly beneficial ; its use, however, should be 
limited strictly to those cases in which the patient herself recog- 
nizes its benefit. The temperature of the water should range 
from ioo° to no°, or even 120 Fahr. The subsiding stage of 



123 GENITOURINARY TRACT. 

an inflammation of the vagina will be often best treated with 
vaginal suppositories, which may be used twice daily, the supine 
position being observed for at least an hour after the introduction 
of each one. The following is a useful formula, but its great 
drawback is that it is so liable to stain the linen, which to most 
women is far from agreeable : 

R 

Ext. Opii, grs. xii. 

Acidi Tannici, 5 i. 

01. Theobromae, q. s. 
M. et ft. Suppositoria, No. XII. 
Copaiba, cubebs and sandal- wood oil may also be used with 
advantage, acting, as usual, through the urine. It must be 
understood that they are only used when the urethra is involved, 
that is, the canal leading to the bladder. No mention has, there- 
foie, been made of the employment of these oils in speaking of 
the treatment of other forms of female gonorrhoea, as in them the 
anti-blennorhagics are worse than useless. Occasionally it is 
found necessary, in chronic cases, to wipe out the urethra with a 
probe wrapped in cotton and dipped in a solution of from 20 to 40 
grains of nitrate of silver to the ounce of water, and in some 
instances the solid stick may be employed. 

(As to gonorrhoea, when it has extended to the uterus, or 
womb, little is said here. The affections of the uterus produced 
by it require no distinctive, or peculiar, therapeutic management.) 



CHAPTER XIV. 
Genitourinary Tract. 

The Sexual Relation— Society's Serious Mistake— Maid and Lover— Man and Wife— The 
Very Serious Consequences of Violating the Laws of Nature— A Lengthy Extract 
from the Excellent Work entitled " Lessons in Gynaecology," by the Eminent Wm. 
Goodell, A.M,, M.D., Professor of the Diseases of Women, etc., in the University of 
Pennsylvania in Philadelphia. 

' ' Certain causes of uterine disease there are which I would 
gladly leave unnoticed, for it is hard, in acceptable language, even 
to allude to them. But so wide-spread are the evils resulting from 
them, that to pass them by would be a flagrant sin of omission." 
'Two things come not back,' said the Caliph Omar, ' the sped 
arrow and the spoken w r ord. ' ' ' Deeply impressed by the wisdom 
of this saying, I shall try so to speak on these delicate subjects, 
as never to regret what I have spoken." 

' 'Arguing from a strictly practical and not from a sentimental 
point of view, but with all reverence, I hold that the love inter- 
changed between man and woman is no mere operation of the 
mind, nor sheer intellectual process. However pure this passion 
may be, it is needfully two-fold in its nature. It is an alloy, made 
up, like ourselves, of body and mind ; the grosser mould so 
internuxed with the more ethereal, that the one finds its most 
passionate expression in the fruition of the other. Abstract love 
between the sexes cannot, therefore, exist in any other sense than 
that engendered by blood ties. Forgetful of this absolute law of 
our being, sentimentalists have judged too harshly of Abelard, 
and lavished too one-sided a sympathy upon Heloise. Without 
further comment, the ante-nuptial relations, at least such as 
custom commonly sanctions in this land, — and, I believe, in no 



GENITO-URINARY TRACT. 125 

other — are therefore, when prolonged, very disturbing elements to 
a young girl's health. Long engagements, by keeping up a 
wearing nervous erethism, are not only recognized, but even 
classified, by alienists, as one of the causes of insanity of women. 
Much more frequently the nervous exaltation is spent upon the 
reproductive organs ; for there follows an awakening of sense 
which is not, as in man, appeased by the distractions of business 
pursuits. Uterine trouble from this source any open-eyed pltysi- 
cian will over and over again see. Now, it is true that in love 
affairs the physician must be no meddler ; matchmaking is 
certainly not his business. But, as a tried and valued friend, as a 
brother beloved, he can speak out when others may not even 
hint. Or, when consulted by an anxious mother about symptoms 
in her daughter plainly referable to the reproductive organs, he 
can disclose the cause, and thus be the means of hastening on the 
cure. ' ' 

' ' If the caresses of lovers are prejudicial to good health, every 
like relation between the sexes must be exposed to like dangers. 
In too many rural districts, and in the lower classes of citizens, 
such license is tolerated in the social intercourse between the 
youth of each sex as must be destructive both to good health and 
to good morals. But, since it is not to my present purpose to 
appear as a social reformer, I shall confine my remarks to the 
hygienic aspects of the subject. The "old folks" are shelved 
too soon. Young people are left too much to themselves, and 
thrown too much together. Their social gatherings are too rarely 
presided over by their mothers or their seniors. As a very natural 
consequence, their games become coarse, their forfeits immodest, 
and, little by little, this freedom from restraint is liable, finally, to 
degenerate into such gross familiarities as would be improper 
even between affianced lovers. An unnatural sexual excitement 
is thus kept up, which must do physical harm. Of the moral harm, 
I say nothing. In this matter I am plainly at a loss to see how 
a physician can interfere in any other way than by setting a good 
example in the order and decorum of his own household. A 
nimbler wit than mine may work out some better way, if so, his 
be the credit : I do but throw out hints. ' ' 



126 GENITOURINARY TRACT. 

"The excesses of the honey-moon journey, conjoined with 
its fatigues and its discomforts are too often the starting-point of 
uterine disease. Here again, will the family physician delicately 
proffer his counsel. In chosen words he can hint at moderation 
in all things, and suggest the avoidance of the usual exhausting 
round of travel and sightseeing. Such words will then, indeed, 
be spoken in season. He must, still further, take cognizance of 
the sexual relations between husband and wife, relations which, 
when abused, are productive of much mischief. All excess in 
that direction he will discountenance. Unmastered importunity 
and too submissive an affection must be met by separate beds, by 
uncommunicating rooms, and if need be, by strong expostulation. 
Criminal abortion he must denounce, and that boldly, if he value 
the health and the happiness of his fellow-creatures, and a clear 
conscience before God and before man." 

" But there are other secret sins which, like the plague of the 
frogs, creep out into houses and bed-chambers, and beds — sins 
which, although vile and filthy, concern us as physicians. The 
wise son of Sirach has laid down the abstract truth, that ' ' the 
knowledge of wickedness is not wisdom ;" and yet, for the correct 
interpretation of diseases, we must intrepidly search out their 
causes, whether moral or physical, however loathsome or impure 
they may be. " 

" It is a well known fact that many men who should be the 
heads of large families, are practicing detestable arts to avoid 
offspring. Plrysicians are so often approached, perhaps indeed 
hard pressed, by husbands, and for the matter of that by wives 
also, for some method of congress unattended by the risk of 
impregnation. They are often consulted also for the mental and 
bodily infirmities resulting from these and other sexual sins. ' ' 

"My purpose, in this article, is less to discuss the moral 
obliquity of these secret sins of the community than to show the 
resulting disorders. Yet I shall not limit myself to the one point 
of view, for the conjugal relation is two-fold in its nature ; it has 
a moral as well as a physical expression, but so interwoven that 
it is hardly possible formally to dissociate them. Nor would it 
be wise for a physician so to do ; for who, so well as he, can 



GKXITO-URINARY TRACT. 127 

determine how far a disturbance in the one will affect the other? 
Moreover, so irreparable is the moral and physical degradation 
resulting from these vicious sexual relations, so damaging are they 
to good health and to good morals, so fatal to national prosperity, 
that I cannot go far astray in assaulting them with every available 
weapon." 

" You have all, no doubt, had a religious training and respect 
the teaching of the Bible ; let us see what light they throw on the 
conjugal relation. The first words addressed by God to our first 
parents conveyed the following blessing and command : ' ' And 
God blessed them, and God said unto them, be fruitful, and mul- 
tiply and replenish the earth." The same blessing and the same 
command, in precisely the same words, were twice given to Noah. 
Abraham and Ishmael received the same blessing, and so did Isaac 
thrice in one chapter. Laban's household sent away their sister 
Rebekah with the same blessing. " Give me children or else I 
die," was the cry of Rachel. Jacob called his offspring "the 
children which God hath graciously given thy servant ; ' ' and the 
same patriarch, when dying, raised himself upon his staff in order 
with greater solemnity to invoke upon his beloved son Joseph 
"blessings of the breasts and of the womb." The Psalmist 
declares that ' ' children are a heritage of the Lord : and the fruit 
of the womb is his reward," while the curse pronounced upon 
idolaters by an indignant prophet is, ' ' Give them a miscarrying 
womb and dry breasts. ' ' In Exodus we read that if a man, ' ' take 
him another wife, her food, her raiment, and her duty of marriage, 
shall he not diminish. ' ' 

' 'Throughout the Old Testament, you will find that fruitfulness 
w r as regarded by Jew and Gentile as the greatest of earthly bless- 
ings, and that as such it was withheld from the wicked. How a 
profanation of this blessing was regarded by God, you all know 
from the history of Onan, who was slain for disobeying a divine 
command by resorting to one of the ' ' preventive measures ' ' in 
vogue at the present day. Again, in the New Testament we find 
St. Paul giving the following advice to the married Christians at 
Corinth : ' ' Defraud ye not one the other, * * * that Satan 
tempt you not for your incontinency. Let the husband render 



128 GENITOURINARY TRACT. 

unto the wife due benevolence ; and likewise also the wife unto* 
the husband," etc. I have not the time to quote all that the 
apostle says upon the subject ; but mind you, this advice was given. 
in troublous and persecuting times ; times in which the temptation. 
was great to prevent the increase of families ; times to which 
the words of our Saviour were especially applicable : ' ' Woe unto- 
them who are with child, and to them that give suck in those days. ' ' 
' ' To these Scriptural precepts and blessings you may perhaps-. 
object that they were designed for special purposes, and that, as 
such, they cannot concern the present generation of men. While 
unwilling to admit this, I reply that there is a natural religion as- 
well as a revealed religion : the one, God's book ; the other. 
Nature's — a "Second Bible," as Bacon happify terms it. You 
have heard what the one enjoins ; now listen to the teachings of 
the other. "A. B., aged 30, married ten years ago, has had two 
children, one of them dying shortly after birth. Six years ago 
she and her husband came to this country and opened a small 
store. She was at that time in robust health, ' ' very happ}*, ' ' and 
cheerfully waited on their customers. For no assignable reason, 
her health soon began to fail, and six weeks ago she came for 
advice in a truly pitiable plight. To use her own language, she 
was ' ' very weak and miserable ; " " crying all the time ; " ( ' can- 
not remember anything for ten minutes ; " " forgets the price of 
the goods in her husband's store ; " " was constantly mislaying 
needful articles, and making wrong change." She was "very 
suspicious," fancied " that everybody was against her and talking 
about her," and confessed of being extremely jealous of her hus- 
band. In addition to these mental disturbances, she eructates large 
quantities of wind, is obstinately costive, has violent palpitations- 
of the heart, and cannot go up one flight of stairs without getting^ 
out of breath. She often staggers, looses consciousness, and 
sometimes falls from vertigo ; is annoyed by a persistent globus 
hystericus, and has no appetite whatever. The catamenia appear 
every three weeks, are abundant, but unaccompanied with pain. 
She has, however, a constant pain in the sacral and in the left 
infra-marumary region ; also a frequent desire to pass water, and 
much ' ' bearing down ' ' of all the pelvic organs. ' ' 



GENITOURINARY TRACT. 1 21T 

" Without wearying you with everj T detail, in one word, the 
subjective symptoms of uterine disease which she presented were 
more numerous and more marked than I had ever before seen in one 
patient. In making a vaginal examination — to which she reluc- 
tantly submitted — I was struck with the excessive sensitiveness of 
her tissues, and with the uncontrolable excitement under which 
she labored — symptoms hitherto in my experience limited to un- 
married women addicted to self abuse." 

" Finally, she flinched from any pressure, however light, over 
each ovarian region. I explained the significance of these symp- 
toms to her. She then took me aside, and, unsolicited, told me 
her history. Being in straightened circumstances upon their 
arrival in this county, and withal anxious, to lay by money, she 
and her husband agreed to have no more children. With this 
view 7 , she had submitted to the following fraudulent and one sided 
expedient at the height of the orgasm the husband withdraws from 
her person, and thus sins as Onan sinned. For six years such 
incomplete coitions had been practiced, usually as often as five 
times, and never less frequently than three times, a week. She 
had at first attributed her ill health to change of climate, but quite 
recently had begun to suspect its true cause from an unexpected 
improvement in all her symptoms during the casual absence of her 
husband on business. ' ' 

" Prompted by this suspicion, she came to consult me as 
to its correctness, and actually, in case it was confirmed, 
to learn from me some other preventive method of congress. 
I explained to her the sinfulness of her conduct, and urged her to 
receive the approaches of her husband in a natural way, as other- 
wise nothing could be done for her. This, however, she flatly 
refused to do, saying she would much prefer a separation, or even 
a divorce from him. Upon inquiry, I learned that her " husband 
was not the man he used to be :" that he was morose and 
dyspeptic, complaining much of general weakness and loss of 
appetite. Two weeks later, she came with much glee to say 
that by a mutual agreement this incomplete act of coition was in 
future to be limited to twice a week, and that she was now ready 
for treatment, whereupon I refused to have anything more to do 



130 GENITOURINARY TRACT. 

with her ; and I have not seen her since. This then is the 
history of a woman whose health is shattered, whose morals are 
perverted, whose mind is verging towards insanity. Now, what 
plrysical law of her being, what moral obligation has been broken ? 

" Wiry has nature been so resentful, and why these fierce 
reprisals ? These are questions which press for an answer. ' ' 

' ' The sexual instinct has been given to man for the perpetu- 
ation of his species ; but, in order to refine this gift and to set 
limits to its abuse, it has been wisely ordered that a purely intel- 
lectual qualit3 T — that of love — should find its most passionate 
expression in the gratification of this instinct. Dissociate the 
one from the other, and man sinks below the level of the brute. 
Destroy the reciprocity of the union, and marriage is no longer an 
equal partnership, but a sensual usurpation on the one side, and 
a loathing submission on the other. Consider the moral effect of 
such shameful manoeuvres ; wedlock lapses into licentiousness ; 
the wife is degraded into a mistress ; love and affection change 
into aversion and hate. Without suffering some penalty, man 
cannot disturb the conditions of his well-being or trespass beyond 
its limitations. Let him traverse her physical laws, and nature 
exacts a forfeit ; dare he violate his moral obligations, an offended 
Deity stands ready to avenge them. That this law is immutable, 
witness from the history I have just given } 7 ou, the estrangement 
between husband and wife ; witness his ill health and ill temper, 
and the wreck of body and of mind to which she has been reduced. 

" The husband suffers mentally, because no man can behave 
in so unmanly a way without a keen sense of self abasement, 
without being stung by the chastisement of remorse. Dishonor 
the body, the temple of the soul, and you dishonor the soul. 
Again, by this cowardly recoil, his enjoyment in the act is so 
blunted that he is tempted to seek elsewhere for those pleasures 
which are denied him at home. Further he suffers physically, 
because, although he passes through the crisis of the sexual act 
and completes it in that sense, yet, owing to his withdrawal from 
the person of his wife just before the moment of ejaculation, this 
acme of the orgasm, by the lack of the normal and needful adju- 
vant — viz. , the rugous and constringing vagina — is not sufficiently 



GENITOURINARY TRACT. 131 

prolonged to wholly empty the rasa dcferentia. Enough of the 
semen remains behind to tease his organs and to kindle in him 
desires too importunate to tolerate an}' great self control. He is 
thus oroaded on to such sexual excess as no brain nor brawn can 
long support ; for a constant drain on the lif egiving fluid implies a 
constant expenditure of nerve force. Early exhaustion and pre- 
mature decrepitude will inevitably ensue if this practice of " con- 
jugal onanism " is persisted in. Nor is this name a misnomer ; 
for there is no essential difference between this habit and that of 
masturbation. Both injure in precisely the same way, and for 
precisely the same reasons. It does indeed seem to be the law of 
Nature that man must suffer the punishment of the onanist if he 
parts with the ' ' seed of another life ' ' in any other way than in 
that by which it tends to become fruitful." 

" The wife suffers the most, because she both sins and is 
sinned against. She sins, because she shirks those responsibilities 
for which she was created. She is sinned against because she is 
defrauded of her rights. Lawful congress completely performed 
so far satisfies an imperious instinct, that attendant local conges- 
tions are at once relieved, and to great nervous excitement succeeds 
a calm repose of body and mind. On the other hand conjugal 
onanism provokes in her desires which keenly solicit that 
very gratification which is denied by the nature of the act. 
The excessive stimulation of the whole reproductive apparatus 
wdiich keeps up, as in the case noted, a sexual excitement 
remains unappeased. A nervous super excitation continues, 
and a hypersesthesia of the parts. By forfeiting her conjugal 
rights, she does not reach that timely conjuncture which loosens 
the tensions of the coarctative muscles of her erectile tissues. 
Hence the congestive orgasm of the vagina, womb, oviducts, and 
of the ovaries, does not at once pass away, but persists for some- 
time — perhaps is not wholly effaced before another incomplete 
coition brings a fresh instalment. Thus arise engorgements, 
erosions, and displacements of the womb, and inflammation of its 
appendages, accompanied, of course, by all those protean mental 
and physical manifestations which I have shown you in the case 
of "Mrs. A. B." She takes distorted views of life and of the 
marriage relation, and harbors resentment against her husband as 



132 GENITOURINARY TRACT. 

to the author of all her ills. But we have not yet done with the 
train of evils. The uterine, ovarian, and vaginal plexus of veins, 
inosculate freely with the hemorrhoidal vessels, and consequently 
with the portal vein (which goes to the liver). Hence the tume- 
scence of the one group of blood-vessels leads to the engorgement 
of the other, and the persistent congestion of the intra-pelvic veins 
determines portal obstruction, and vice versa. The great vascu- 
larity and the erectile structure of the reproductive organs, favor 
this turgescence. As a consequence, functional derangement of the 
liver are commonly associated with uterine disease. To this inter- 
dependence may we refer the obstinate costiveness, the vertigo, 
the loss of appetite, the dyspeptic melancholy, and the suspicious 
nature of the person spoken of." 

' ' Again — for the ill effects of such practices accumulate — the 
very barrenness aimed at by these criminal expedients is in itself 
a source of disease. In sterile women the absence of pregnancy 
and of suckling prevents a break in the constantly-recurring cata- 
menia, and the physiological congestions of the womb augmented 
by the sexual congestions are, by careless repitition, liable to 
become pathological. Add to this the unrelieved congestions 
arising from incomplete intercourse, and a prolific source of uterine 
and of liver disorders is at once manifest." 

" Now there are other artificices — nay, even equipments bor- 
rowed from the brothel — for the purpose of avoiding conception, 
which may well alarm publicists and statesmen. For, vile as they 
are, the} 7 have received the open sanction of those English political 
economists who forgot that crime and vice and human suffering in 
their land are due less to ' ' over-population and large families ' y 
than the absenteeism, to laws of primogeniture and of entail ; to 
the grasping avarice of the rich, and to the intemperance, ignor- 
ance, and shiftlessness of the poor. All these expedients operate 
by directly preventing the access of the spermatozoa to the uterine 
cavity, by destroying them, or by washing them away ; but they 
are all hurtful equally to mind and bod}-. If it is hazardous for 
an overheated stomach to receive a glass of water — its natural 
and accustomed beverage — how much more will it be to deluge 
the over- congested womb with such foreign fluids as simple or 
astringent injections ! " 



GENITOURINARY TRACT. 133 

" For the limitation of families, some conscientious political 
economists recommend absolute abstinence. But, if the " nervous 
erethism ' ' of long engagements is assigned by alienists as a com- 
mon cause of insanity, and by physicians as a freqent source of 
uterine disturbance, what derangement of body and of mind may 
not spring from this forced continence ! Perhaps, however, we 
are wasting words on impossibilities. There is a wide-spread 
delusion, as old as the art of medicine itself, that intercourse after 
the tenth day following the cessation of the menses is not attended 
with the risk of impregnation. But ovulation is not necessarily 
menstruation ; and he who constructs domestic time-tables or 
trusts to his almanac, will find that accidents can happen in the 
best regulated family. If he protract the time of intercourse to a 
still later period after menstruation, he is liable to inseminate an 
-ovum near the os uteri, and thereby produce placenta praevia. If 
he perform the act during menstruation, he is likely to bring about 
a pelvic haematicele, a pelvic peritonitis, or even an extra uterine 
pregnane}-. Over-lactation to avoid the dreadful accident of 
motherhood is not only a very fruitful source of disease in women, 
but it very seriouslj' compromises the health of the child ; for it 
causes rachitis, cholera infantum, and the wasting diseases of 
children. On the other hand, if the mother, when pregnant, con- 
tinues to nurse her child, in order to bring on an abortion, the 
child is sure to suffer from the deteriorated milk, and the mother, 
from the double demand upon her vital energies." 

" In a late discussion before the British Medical Association, in 
w T hich some of the foremost men of England took part, it was the 
unanimous verdict that over-breeding does not produce ill-health 
so much as efforts to prevent conception. The venerable West, 
accuses ' ' the imperfect performance ' ' of sexual intercourse as one 
of the frequent causes of uterine engorgement, and of enlargement 
of the cervix * * * L,ike disorders, from like causes, I have 
so often seen, that when called to a case of pelvic inflammation, I 
take it for granted that means have been adopted for preventing 
conception * * * There are, in fact, no harmless or available 
means for thwarting nature's plain intention ; for if they should 
not happen to injure the body, they assuredly will the mind. How 



134 GENITOURINARY TRACT. 

immoral must be the effect when husband and wife meet, not ' ' to 
endear each other ' ' — as Jeremy Taylor quaintly has it — but to 
adjust accoutrements, to compound antidotes, and to consummate 
with prearranged precautions and cold-blooded calculations a union 
which for its perfect mental and physical fruition, should be spon- 
taneous and unrestrained ! All these artifices soil the purity of 
thought, and degrade marriage into a carnal compact which regards 
alone the needs of the flesh. ' ' 

1 ' Such, then, are my views upon the so called ' misery checks' 
and ' common sense measures ;' and I feel that they can not be 
gainsaid. I dare any political economist to show me one innocuous 
expedient whereby conception can be avoided. I challenge him to 
name a single preventive plan which will not do damage either to 
good health or to good morals. Even natural sterility is a curse. 
Show me a house without children, and, ten to one, you show me 
an abode dreary in its loneliness, disturbed by jealousy or by 
estrangement, distasteful from wayward caprice or from unlovable 
eccentricity. Depend upon it, there are no thornless b}--paths by 
which man can skulk from his moral and physical obligations ; no 
safe stratagems by which he can balk God's first blessing and first 
command. * * * " 



CHAPTER XV. 

GENITOURINARY TRACT. — LACTATION 

Wet Nursing— Disadvantages to a Healthy Woman if She Does not Nurse Her Infant. 
Bodily Disease, Sore Breasts. Cancer or Uterine Diseases Often Result if Nursing 
is Neglected. Mechanical Means. Diet and Medical Agents, "Which Promote 
the Secretion of Milk. How to Check an Over-Abundant Secretion of the L-acteal 
Fluid. The Influence of Coffee on the Mammary Secretion. Treatment of Sore 
Nipples. Different Kinds of Nipple Shields. 

Should a healthy woman suckle her children ? This, and 
the disadvantages which are likely to result to herself if she does 
not, are what we should first consider. Burdach, a French writer, 
says : " It is always delightful to perform a duty, how much more 
a maternal obligation." Is there a more delightful occupation for 
a mother than to watch the little babe hanging upon her breast, so 
helpless, and yet so fondling, nestling so closely to her, and 
feeding so contentedly upon her milk ? Is there any way by 
wdiich love can be more riveted between two beings, in such 
intimate relation ? ' ' Can a woman forget her suckling child ?' ' 
And w T hen every day brings new pleasures, and ripens on both 
sides the mutual affection — when the child thrives well, and, as if 
in tender gratitude, lies smiling upon the mother's lap, what a 
comfort, what a happiness for the mother ! It is scarcely credible, 
yet a painful evidence of our fallen nature, that there are to be 
found those who can so far forget themselves, and their responsi- 
bility before God and man, as to neglect the performance of those 
duties ; nay, who will even conceive them irksome, because for a 
time, they interfere with their pleasures and frivolities. Could 
the brute creation speak, they would cry " shame" upon such 
mothers, and all nature united would re-echo the cry upon such 
selfish and cruel women. But this is not all. The mother will 



136 GENITOURINARY TRACT, 

not only suffer moral punishment. In this matter the chances are 
that she will find that if she sows to the flesh, she has of the flesh 
to reap corruption. Not only may her own natural feelings and 
those of her offspring towards herself become blunted and callous, 
but she may, also be the victim of immediate bodily suffering, 
perhaps, ultimately, of loathsome disease. Through this unnatural 
neglect, painful distention of the breast, fever and very painful 
abscesses may occur, which, by weakening the system, lay the 
foundation of exhaustive diseases, such as anaemia, indigestion 
and even consumption. Cancer and other diseases of the breasts 
are much less frequent in women who suckle their infants than in 
those who, for some inexcusable cause or other, neglect this 
maternal obligation. But more than this. If a woman bears 
children too frequently and too rapidly, which is a likely occur- 
rence if she does not suckle, or does so for too short a period, 
disease may be thereby engendered in her offspring, who will 
often prove diseased and weakly, and it is to be feared that the 
mother may not have the satisfaction of seeing her children attain 
the age of maturity. The laws of nature are irrevocable, and no 
woman can afford with impunity to maintain a code of her own, 
in defiance of them. If there be any doubt as to the influence of 
not sucking upon the production of cancer of the womb, there is 
none whatever on its influence in the development of other 
diseases of the womb, often of a very severe and painful kind, of 
long duration usually and frequently incurable. Owing to the 
sympathy which exists between the breasts and the womb, if the 
function of these organs be not properly fulfilled, the other is sure 
to suffer. The immediate effect upon the womb of sucking, is to 
cause it to contract. Hence the reason that sucking a breast when 
a woman is flooding often causes the flooding to cease, by directly 
exciting the wished for contraction. When pregnancy has 
terminated, the volume of the uterus is still very large, and, unless 
it becomes lighter, it will, by its weight, have an increased 
tendency to sink, or fall, and become displaced otherwise as by 
flexions and versions. Such is especially the case in weakly women, 
or in those who get up too soon after their confinements. Hence 
the need of the maintenance of a contracting influence of the 



GEXITO-URINARY TRACT. 137 

womb, to promote its absorption and diminution of size, and this 
is what suckling brings about gradually, but effectively. The 
organ becomes reduced in volume and finally acquires a healthy 
standard. If this condition be not arrived at, then the womb 
remains large and heavy. Bearing down sensations, back-ache, 
bladder trouble, copious leucorrhcea, etc., result, due to inflam- 
mation of the lining membrane of the womb (endometritis) and 
congestion of the organ, ulceration of the mouth of the uterus, 
etc. , with all the distressing and painful consequences. Thus, for 
a brief time of selfish gratification, a life may be made miserable 
and severe penalty be entailed. So a woman may esteem herself 
fortunate if cured after months, or, perhaps, years of suffering. 
But there are a great number of good mothers who would only 
be too happy to perform this sacred duty and nurse their children, 
if the}* only possessed or could provide the necessary quantity of 
breast milk to do so, and it is mainly on account of this class of 
unfortunates that this discourse is written, so as to suggest proper 
ways and means to secure the necessar3 r amount of lacteal secre- 
tion. This trouble is known as defective lactation, and it may 
result from various causes. Among them may be mentioned — 
age, paralysis, fear, and mental emotions generally, and disease 
of the sexual organs (with, or without, atrophy of the breast), 
excessive fat, and a tendency generally to the deposition of fat in 
. and about the breasts ; impure air, debility, too sedentary a life, 
want of proper exercise, and so on. 

There are certain mechanical and physiological methods of 
inducing a flow of milk in the breast, provided that none of those 
powerful mental influences we have already spoken of are present 
to paralyze the functions. Many suckling mothers have com- 
plained to me of the extreme annoyance to themselves and the 
child when it is put to the breast — their maternal feelings being 
severely wounded on account of the attempt, on the part of the 
child, to procure milk from what appeared to be a dried-up breast. 
Among the most powerful preservatives of the milk secretion, 
the first to be noticed is suction from the nipple, which faculty 
nature has implanted in infants even though unconscious of its 
existence themselves. There are many cases on record in which 



138 GENITOURINARY TRACT. 

this has produced the flow of milk in women who have never borne 
children, and even in men. Baudelocque mentions the case of a 
girl, eight years old, who suckled her brother for a month, and 
cases at the opposite extreme of life have been reported ; one of 
a woman of seventy years, who wet-nursed a grandchild twenty 
years after her last confinement. Travellers among barbarous 
nations or tribes, have often observed these cases of unnatural 
lactation. Humboldt saw a man, thirty-two years old, who gave 
the breast to his child for five months, and Captain Franklin, in 
the Arctic regions, met a similar case. Dr. Livingstone, in his 
account of Africa, sa}-s, that he examined several cases in which 
a grandchild was suckled by a grandmother, and equally remark- 
able instances of lactation occur among the negroes of the 
Southern and Middle States. Professor Hall presented to his class 
in Baltimore a male negro fifty-five years old who wet-nursed all 
the children of his mistress. In these cases of abnormal lactation, 
so far as we have complete records of them, it is ascertained that 
the breasts were torpid, and even sometimes, as in old people 
atrophied (wasted) till the nursing commenced. Another mode 
of increasing the functional activity of the milk glands is by 
electrical currents, but this should only be performed by a skilled 
physician and not practiced by inexperienced people. 

In all cases of insufficient secretion of milk, the regimen of the 
mother is a matter of importance. Personal and domiciliary clean- 
liness are essential for successful wet-nursing. A certain amount. 
of exercise in the open air is conducive to the health of the mother, 
and to the secretion of abundant and healthy milk. A case is- 
related by a learned medical writer of a lad} 7 of cleanly habits, 
living in London, who had a very scanty supply of milk. She- 
removed to the pure air of the sea shore, and immediately the 
quantity became abundant, and continued so for months. Such 
cases are not infrequent. A mode of life that contributes to the 
general health of the mother will not fail to augment the quantity 
of her milk, if it is scanty, and to improve its quality. 

Much has been written in reference to the diet of women who 
suckle. It is a popular belief that certain articles of food promote 
the secretion of milk much more than other articles, though equally 



GENITOURINARY TRACT. 139 

nutritious. Xo doubt, writers have erred in recommending exclu- 
sively this or that kind of food, as most likely to produce milk. 
The exact kind of food which is preferable, in certain cases 
depends partly on the physique of the individual, and partly on 
the character of the food to which she has been accustomed. A 
mixed diet contributes most to the sustenance of the mother, and 
to an abundant secretion of milk , Animal substances which fur- 
nish a due supply of nitrogenous aliment, should be given with 
the farinaceous (starchy). Mothers pallid, and inclining to an 
anaemic condition, require a larger proportion of animal diet than 
those in good general health. On the other hand, plethoric women, 
who with excellent appetites consume large quantities of food, and 
who become more and more full blooded and corpulent while the 
milk diminishes, require a more restricted animal diet, in connec- 
tion with frequent exercise, especially in the open air. There are 
certain kinds of food which do appear to have a galactogogue effect, 
with most wet-nurses. Oatmeal gruel is one of these. Wet-nurses 
often remark, after taking a bowl of this, that they feel the flow 
of milk. Cow's milk, with some has a similar effect. Porter or 
ale taken once or twice a da}', also promotes the secretion of milk, 
especially in those who have poor appetite, and whose systems are 
somewhat reduced. A great variety of medicines have been used 
for their galactogogue effect. Medicines which improve the gen- 
eral health are, no doubt, sometimes useful for this purpose, such 
as the vegetable and ferrugnous tonics, and perhaps cod-liver oil. 
But there are other medicines which, it is claimed, have a specific 
effect on the mammary gland promoting its secretino. Lettuce, 
winter-green, fennel, the broom tops (cytisus scoparius), marsh- 
mallow, castor oil plant, and many other plants have been used 
for the purpose. There can be no doubt that the aromatic stimu- 
lants, as fennel, anise, and caraway seeds, given in soups, some- 
times stimulate the lacteal secretion. But the medicine, which of 
late has attracted most attention, as a galactogogue, is castor oil 
and the plant from which it is derived. The galactogogue effect 
of the leaves of the castor oil plant has been long known to the 
Spaniards in South America. At least, as long ago as the com- 
mencement of the last century, the castor oil leaves were applied 



140 GEXITOURIXARY TRACT. 

by thern externally to the breast, to promote the secretion of milk. 
It is now about twenty 3-ears since this use of the plant was brought 
prominently to the notice of the profession in this country and in 
Europe. In the London Journal of Medicine, 1857, Dr. Tyler 
Smith relates the results of his experiments with the castor oil 
plant. He applied the bruised leaves over the breasts, and wit- 
nessed as he thinks, an evident galactogogue effect. Dr. Routh 
has also made pretty extensive use of the plant, both externally 
and internally. He was led, he says, to employ it internally by 
noticing in suckling women an increase of milk, after taking a 
dose of castor oil. He prescribed a decoction of the leaves and 
stalks, and says : "I have not been disappointed. The flow has 
been remarkably increased. The breasts should at the time 
of its use be covered with a fomentationof leaves ; or an extract 
of the leaves should be rubbed over the breasts in the same way 
in which extract of belladonna is used, and over this a warm 
poultice applied of the ordinary material." Dr. Routh remarks : 
' ' When the castor oil leaves are given as an infusion to women 
who are not suckling, I have observed two effects, both of 
which seem to denote its specific action. First, it produces 
internal pain in the breasts, which lasts for three or four days. 
Then, secondly, a copious leucorrhceal discharge takes place, after 
which the effect on the breasts entire!} 7 disappears. Dr. Gilfillan, 
of Brooklyn, has also employed the castor oil leaves successfully 
as a galactogogue. He emplo} T ed a poultice of the pulverized leaves, 
and gave internally the fluid extract of the leaves, a teaspoonful 
three times daily. The patient had been confined the year before 
with her first child, but had no milk for it, though her health was 
good and measures were employed, such as friction and fomenta- 
tions, to stimulate the secretion. The castor oil was prescribed 
the fourth day after her confinement with the second child, when 
there were no signs of secretions and the breasts were small. 
" About two hours after the poultice was applied, and the first 
dose taken, she experienced a strange sensation in the breasts, and 
this increased after each dose of medicine. The poultice was not 
renewed, but the extract was continued for three da3'S, after which 
lactation was perfectly successful." So far observations have 



GENITOURINARY TRACT. 141 

shown that the castor oil plant is the most efficient galactagogue 
which we possess among medicinal agents. 

Dr. A. Harkin highly praises chlorate of potassium as a potent 
galactagogue. He has used it over fifty years, during which time 
he never found it to injure either mother or child. His prescrip- 
tion is as follows : 
R 

Potass. Chloratis, 3vii (7 drachms). 

Aquae Destillatce, §xviii (18 ounces). 

M. Sig. : One ounce three times a day before meals. 
Castor oil for this purpose maybe given in teaspoonful doses, 
two or three times a da}-, mixed with extract of malt which dis- 
guises its taste completely and increases its efficacy. 

COFFEE AND LACTATION. 

Dr. Alice McLean states {Medical and Sicrgical Reporter) , 
that in an institution of which she had charge recently, in which 
there were about thirty nursing women, coffee was served twice a 
week. Regularly upon those days the nurses in charge reported 
a scarcit3 T of breast milk, and there was frequently a necessity for 
resorting to artificial feeding to eke it out. To the obvious 
suggestion of abstinence in such cases, is added the complementary 
suggestion that coffee might be useful where the secretion becomes 
undesirable or excessive. 

The opposite condition sometimes exists in reference to the 
secretion of milk — that is, there may be an excessive, or super- 
abundant, flow of the lacteal fluid, to which the term galactor- 
rhea is applied ; and because of its tendency to exhaust the 
mother, requires proper treatment, to lessen its flow. There are 
medicines which cure this affection by diminishing the amount of 
milk. Belladonna, iodide of potassium, and colchicum are anti- 
galactics (agents to lessen the secretion of milk). It is some- 
times proper to use them in case of weaning or of death of the 
infant. They may not only reduce the quantity of milk, but, 
continued, may prevent its secretion. They are employed not to 
benefit the infant, but the mother. On the other hand, if it is 
our purpose to prevent the oozing of milk in order to save it for 



142 GEXITO-URIXARY TRACT. 

the infant, or, if it is abundant and watery, to diminish somewhat 
its quantity and improve its qualhw, the treatment should be 
different. Iron, in cases of excessive secretion, in which the 
condition of the system appears to indicate the need of it, will 
diminish the quantity of the milk and render it richer. It should, 
however, not be too long continued as it might lessen the secre- 
tion so much as to necessitate the weaning of the infant. 

Sore nipples and imperfectly developed nipples, require local 
treatment. Sore nipples may be treated by — i. Soothing appli- 
cations. Some recommend lead lotion or opium lotions. In mild 
cases honey, gum, solut. tulu, or Friar's balsam, maj^ be applied 
by a camel's hair brush every time the child has suckled. Fuller's 
earth or bismuth sometimes proves useful. 

2. By caustic application. For sore nipples the application 
of various caustic solutions, or even of the solid nitrate of silver, 
are very efficacious. 

3. Shields. These are generally of four kinds — the cow 
udder, caoutchouc, glass and wood. The cow udder is an old 
woman's and a very popular medium ; and if kept very clean and 
frequently renewed is as good as any of them. The caoutchouc 
nipple is, however, generally preferred. Kept in a little water or 
glycerine, when not in use, after having been nicely w T ashed in a 
little warm w T ater, it will remain sweet for weeks. Sometimes the 
shields are made completely of glass or wood, resembling in shape 
and form the ordinary nipple of the areola of the breast, the 
nipple portion being perforated wiih holes. 



CHAPTER XVI. 

DIGESTIVE TRACT. 

Pood for the Sick and Its Administration — Many Valuable Receipts for the Invalid — 
Cookery for the Sick Room — Broths — Soups — Gruels, etc. The Use and Abuse of 
Alcoholic Stimulants— A Pouud of Beef and a Pound of Eggs— How to Vary the Diet 
—Tuberculous and Other Germs in the Milk— Boiling as a Safeguard— A Warning 
Against So-called Infant Foods. The Opinion of Ex-Provost Pepper. 

To provide food for the sick which will be at once suitable 
and acceptable is a matter which requires care, judgement, and 
ingenuity, but it is well worth the expenditure of them all. The 
aim should be to give what will be at once easy of digestion and 
of value after it is digested. 

It is a lamentable fact that physicians as a rule understand 
but little about the culinary art or cooking, as the same is as yet 
not required in their medical curriculum, consequently the duty 
and knowledge devolves almost entirely, upon the nurse or 
attendant and it is very important that persons thoroughly under- 
stand how to provide the proper diet for the sick-room. The 
physician may suggest — but is usually incapacitated to prepare it 
and the attendant can not be too well possessed of the under- 
standing how to provide food for the sick. It is with this object 
in view that this chapter is written. 

All soups should be allowed to stand until cold as the fat can Tt-o^ 
be perfectly removed while hot. Heat, when required for use, 
only to the palatable point without further boiling. 

A variety of gruels, porridges, etc., are made of oatmeal. 
Indian-meal, arrow-root, rice-flour, corn-starch, etc. Different 
crushed cereals may be obtained already steam-cooked, which will 



144 DIGESTIVE TRACT. 

be found excellent and very convenient as they take very little 
time for preparation. Directions for use are supplied with them. 

Both oatmeal and Indian-meal have a loosening effect upon 
the bowels, and are consequently objectionable when there is any 
tendency to diarrhoea. In such cases boiled milk is preferable to 
raw. When there is nausea arising from over-acidhv of the 
stomach, limewater may be added to the milk, in any proportion 
up to one-half. If there is also constipation, carbonic-acid water 
or Vichy is to be preferred. Skimmed milk can often be taken 
when the cream can not, and it should be remembered that this 
contains all the elements of nutrition. Buttermilk is also good. 

Milk may be kept for some time from souring, even in warm 
weather, by adding to each quart fifteen grains of bi-carbonate of 
soda, and a little sugar. 

The following receipts for sick cookery are all of tested value, 
and simple enough to be used successfully by the least experienced 
in culinar3 T art. 

FIFTY FORMS OF FLUID FOOD. 

Beef-tea. — Take a pound of juicy beef cut from the round,, 
remove all the fat, and cut into very small pieces. Put in an 
earthen pot and add a quart of cold water. Cover it closely, let it 
soak for an hour, and then gentry simmer for two hours more, or 
until the strength is quite extracted from the beef. Strain, and 
season with salt and pepper. 

Beef -essence. — Mince finely a pound of lean, juicy beef, from 
which all the fat has been removed ; put into a wide mouthed 
bottle or fruit jar, and cork tightly. Set the jar into a kettle of 
cold water over a slow fire, and let it boil for three hours. Strain 
and season with salt and pepper. 

Peptonized Beef -tea. — To half a pound of raw beef, free from 
fat and finely minced, add ten grains of pepsin, and two drops of 
hydrochloric acid. Put in a large tumbler, and cover with cold 
water. Let it stand for two hours at a temperature of 90 , being 
frequently stirred. Strain and serve in a red glass, ice-cold.. 
Peptonized food does not keep well, and should never be used 
more than twelve hours old. 



DIGESTIVE TRACT. 145 

Beef -juice. — Place half a pound of lean, juicy beef on a broiler, 
over a clear hot fire, and heat it through. Press out the juice 
with a lemon squeezer into a hot cup, add salt, and serve hot with 
toast or cracker. 

Beef-tea with Oatmeal. — Mix a tablespoonful of well cooked 
oatmeal with two of boiling water. Add a cupful of strong beef- 
tea, and bring to the boiling point. Salt and pepper to taste, and 
serve with toast or crackers. Rice may be used in place of oat- 
meal. 

White Celery Soup. — To half a pint of strong beef-tea add an 
equal quantity of boiled milk, slightly and evenly thickened with 
flour. Flavor with celery seeds, or pieces of celery, which are to 
be strained out before serving. Salt to taste. 

Chicken Broth. — An old fowl will make a more nutritious 
broth than a young chicken. Skin, cut it up, and break the 
bones with a mallet. Cover well with cold water, and boil slowly 
for three or four hours. Salt to taste. A little rice may be boiled 
with it, if desired. 

Mutton Broth. — Cut up fine two pounds of lean mutton, 
without fat or skin. Add a tablespoonful of barley, a quart of 
cold water, and a teaspoonful of salt. Let it boil slowly for two 
hours. If rice is used in place of barley, it will not need to be put 
in till half an hour before the broth is done. 

Oyster Broth. — Cut into small pieces a pint of oysters ; put 
them into half of cold water and let them simmer gently for ten 
minutes over a slow fire. Skim, strain, add salt and pepper. 

Clam Broth. — Take three large clams, and let them stand in: 
boiling water till the shells begin to open. Drain out the liquor,, 
add an equal quantity of boiling water, a teaspoonful of finely- 
pulverized cracker crumbs, a little butter and salt to taste. 

Rice Soup. — Take half a pint of chicken stock and two table- 
spoonfuls of rice. Let them simmer together for two hours, then 
strain and add half a pint of boiling cream and salt to taste. 
Boil up once, and serve hot. 

Peptonized Milk. — Stir up five grains of pancreatic extract 
and fifteen of bicarbonate of soda in a gill of water, mix thoroughly 
and add a pint of fresh milk. Put in a bottle or a covered jug, 



146 DIGESTIVE TRACT. 

and let it stand where it will keep warm for an hour. Then put 
on ice until required for use, or boil for two or three minutes to 
stop further digestive action. Milk so prepared will have a faintly 
bitter flavor; it may be sweetened to taste, or used in punches, 
gruels, etc, like ordinary milk. 

Flour Gntel. — Mix a tablespoonful of flour with milk enough 
to make a smooth paste, and stir it into a quart of boiling milk. 
Boil for half an hour, being careful not to let it burn. Salt and 
strain. This is good in case of diarrhoea. 

Boiled Flour Gruel. — Moisten a pint of flour with a couple of 
ounces of cold water, make it into a ball, and tie it up tightty in a 
strong cloth, sprinkle it with flour, and boil it hard for ten hours. 
Then take off the cloth, and let the ball dry in a slow oven for ten 
hours more. Grate two teaspoonfuls of flour from the dry ball, 
mix it with cold water to a smooth paste, and stir it into half a 
pint of boiling milk. Simmer about three minutes and sweeten. 
This is considered especially good for children while teething. 

Oatmeal Gruel. — Boil a tablespoonful of oatmeal in a pint 01 
water, for three quarters of an hour, then put it through a strainer. 
If too thick, reduce with boiling water to the desired consistency. 
Season with salt. 

Oatmeal Gruel with Milk. — Soak half a pint of oatmeal in a 
quart of water over night. In the morning add more water, ii 
necessary, and boil for an hour. Squeeze through a fine strainer 
as much as 3^ou can, and blend it thoroughly with a pint of boiling 
milk. Boil the mixture for ten minutes and salt to taste. 

Cracker Gruel. — Pour a pint of boiling milk over three table- 
spoonfuls of fine cracker-crumbs. Butter-crackers are the best to 
use. Add half a teaspoonful of salt, boil up once altogether, and 
serve immediately. Do not sweeten. 

Indian-meal Gruel. — Mix a scant tablespoonful of Indian- 
meal with a little cold water, and stir in a pint of boiling water. 
Boil for half an hour. Strain and season with salt. Sugar and 
-cream may be added, if desired. 

Arrowroot. — Mix a tablespoonful of Bermuda arrowroot with 
four of cold milk. Stir it slowly into half a pint of boiling milk, and 
let it simmer for five minutes. It must be stirred all the time, to pre- 



DIGESTIVE TRACT. 147 

vent lumps and keep it from burning. Add half a teaspoonful 01 
sugar, a pinch of salt and one of cinnamon, if desired. In place 
of the cinnamon, half a teaspoonful of brandy may be used or a 
dozen large raisins ma}* be boiled in the milk. If the raisins are 
preferred, the}* should be stoned, and the sugar may be omitted. 
Cornstarch or rice-flour gruel is made in the same way. 

Sago Milk. — Wash a tablespoonful of pearl sago, and soak 
it over night in four of cold water. Put it in a double 
kettle with a quart of milk, and boil until the sago is nearly dis- 
solved. Sweeten to taste, and serve either hot or cold. 

Treacle Posett. — Bring a cupful of milk to the boiling point, 
and stir into it a tablespoonful of molasses. Let it boil up well, 
strain, and serve. 

Milk and Albumin. — Put into a clean quart bottle a pint of 
milk, the whites of two eggs, and a little pinch of salt. Cork, 
and shake hard for five minutes. 

Koumyss. — Dissolve a third of a cake of compressed yeast, 
(Fleischmann's), or its equivalent of fluid yeast, in a little warm 
— not hot — water. Take a quart of milk fresh from the cow, or 
warmed to about blood heat, and add to it a tablespoonful of sugar 
and the dissolved yeast. Put the mixture in beer bottles with 
patent stoppers ; fill, to the neck, and let them stand for twelve 
hours where you would put bread to rise — that is, at a temperature 
of 68° or 70 . Then put the bottles on ice, upside down, until 
w T anted. 

Wine Whey. — Heat half a pint of milk to the boiling point, 
and pour into it a wine-glass of sherry. Stir once round the 
edge, and as soon as the curd separates, remove from the fire and 
strain. Sweeten if desired. The whey can be similarly separated 
by lemon juice, vinegar, or rennet. With rennet whey, use salt 
instead of sugar. 

Mulled Wine. — Into half a cup of boiling water put two tea- 
spoonfuls of broken stick cinnamon and half a dozen whole cloves. 
Let them steep for ten minutes, and then strain. Beat together 
until very light two eggs and two tablespoonfuls of sugar, and stir 
into the spiced water. Pour into this, from a height, a cupful of 
sweet wine, boiling hot. Pouring it several times from one pitcher 



148 DIGESTIVE TRACT. 

to another will make it light and foamy. Serve hot. The wine 
should not be boiled in tin. 

Milk Punch. — To half a pint of fresh cold milk add two tea- 
spoonfuls of sugar and an ounce of brandy or sherry. Stir until 
the sugar is dissolved. 

Eggnogg. — Beat the white of an egg stiffly, then stir into it 
in turn a tablespoonful of sugar, the yolk of the egg, a tablespoon- 
ful each of ice-water, milk and wine. Do not beat but stir very 
lightly. 

Eggnogg Mo. 2. — Beat up one egg with a tablespoonful of 
sugar. Stir into this a cup of fresh milk, an ounce of sherry, or 
half an ounce of brandy, and a little nutmeg. 

Hot Eggnogg. — Beat together the yolk of an egg and a table- 
spoonful of sugar, and stir into a pint of milk at the boiling point. 
Add a teaspoonful of brandy or whiskey, and grate a little nutmeg 
over the top. 

Syllabub. — Dissolve two teaspoonfuls of sugar in a tablespoon- 
ful of wine, put it in a pint pitcher, and take it to the cow. Milk 
into it until the foam reaches the top. 

Egg Water. — Stir the whites of two eggs into half a pint of 
ice water, without beating, add enough salt or sugar to make it 
palatable. Good for teething children with diarrhoea. 

Egg Broth. — Beat together one egg and half a teaspoonful of 
sugar till very light, and pour on a pint of boiling water, stirring 
well to keep it from curdling. Add salt and serve hot. 

Hot Milk and Water. — Boiling water and fresh milk, in equal 
parts, compose a drink highly recommended in cases of exhaustion, 
as it is quickly absorbed in the system with very little digestive 
effort. This is also true of the egg broth above described. 

Le??ionade with Egg. — Beat one egg with two tablespoon fuls 
of sugar until very light, then stir in three tablespoonfuls of cold 
water, and the juice of a small lemon. Fill the glass with pounded 
ice, and drink through a straw. 

Barley Water. — Wash thoroughly two ounces of pearl barley 
in cold water. Add two quarts of boiling water and boil until 
reduced to one quart — or about two hours — stirring frequently. 



DIGESTIVE TRACT. 149 

Strain, add the juice of a lemon and sweeten. For infants omit 
the lemon. 

Toast Water. — Toast three slices of stale bread to a very dark 
brown, but do not burn. Put into a pitcher and pour over them a 
quart of boiling water. Cover closelj', and let it stand on ice until 
cold. Strain. Good for nausea from diarrhoea. A little wine 
and sugar may be added if desired. 

Apple Water. — Slice into a pitcher half a dozen juicy sour 
apples. Add a tablespoonful of sugar, and pour over them a quart 
of boiling water. Cover closely until cold, then strain. Slightly 
laxative. 

Gum Arabic Drink. — Dissolve an ounce of gum arabic in a 
pint of boiling water, add two tablespoonfuls of sugar, a wineglass 
of sherry, and the juice of a large lemon. Cool and add ice. 

Flax-seed Lemonade. — Into a pint of hot water put two table- 
spoonfuls of sugar and three of whole flaxseed. Steep for an hour, 
then strain, add the juice of a lemon, and set on ice until required. 

Pot us Impcrialis. — To a quart of boiling water add half an 
•ounce of cream of tartar, the juice of one lemon, and two table- 
spoonfuls of honey or sugar. Let it stand on ice until cold. 

Irish Moss. — Wash thoroughly a handful of Carrageen moss, 
pour over it two cups of boiling water, and let it stand where it 
w T ill keep hot, but not boil, for two hours. Strain, add the juice 
of one lemon, and sugar to taste. 

Slipper3'-elm may be used in the same way, a teaspoonful of 
the powder to each cup of boiling water. 

Bran Tea. — To a pint of wheat bran add a quart of boiling 
-water. Let it stand where it will keep hot, but not boil, for an 
iour. Strain and serve with sugar and cream. This is palatable 
and nutritious. 

Corn Tea. — Parch brown a cupful of dry sweet corn, grind or 
pound it in a mortar. Pour over it two cups of boiling water, and 
steep for a quarter of an hour. This is light and nutritious. 

Rice Coffee. — Parch and grind like coffee half a cupful of rice. 
Pour over it a quart of boiling water, and let it stand where it will 
kieep hot for a quarter of an hour, then strain, and add boiled milk 
and sugar. This is nice for children. 



150 DIGESTIVE TRACT. 

Crust Coffee. — Take a pint of crusts — those of Indian bread 
are the best — brown them well in a quick oven, but do not let 
them burn ; pour over them three pints of boiling water, and steep 
for ten minutes. Serve with cream. 

Tea. — Tea should be made in an earthen pot, first rinsed with 
boiling water. Allow a teaspoonful of tea to each half pint of 
water. Put in the tea, and after letting it stand for a few moments 
in the steaming pot, add the water, freshly boiling, and let it stand 
where it will keep hot, but not boil for from three to five minutes. 

Coffee. — Stir together two tablespoonfuls of freshly ground 
coffee, four of cold water, and half an egg. Pour upon them a 
pint of freshly boiling water, and let them boil for five minutes. 
Stir down the ground, and let it stand where it will keep hot, but 
not boil, for five minutes longer. In serving put sugar and cream 
in the cup first, and pour the coffee upon them. 

French Coffee. — Some people prefer filtered coffee to boiled. 
This is best made in a French biggin, consisting of two tin vessels, 
one fitting into the other, the upper one supplied with strainers. 
The coffee, very finely ground, is placed in this, and the boiling- 
water allowed slowly to percolate through it. The pot is to be set 
where it will keep hot, but not boil, until the water has gone 
through. Pouring it through a second time will make it stronger,, 
but it looses its flavor. Cafe noir is always made in this way. 

Coffee and Egg. — Boil together for five minutes atablespoon- 
ful of ground coffee, a quarter of a pint of milk, and a quarter of a pint 
of boiling water. Beat an egg and four teaspoonfuls of sugar together 
until stiff and light, and strain the boiling coffee into it, stirring 
all the time. Add two tablespoonfuls of hot cream. This is only 
to be given in small quantities. 

Chocolate. — Scrape fine an ounce of Baker's chocolate, add 
two tablespoonfuls of sugar and one tablespoonful of hot water ; 
stir over a hot fire for a minute or two until it is smooth and per- 
fectly dissolved, then pour into it a pint of boiling milk ; mix 
thoroughly, and serve at once. If allowed to boil after the choco- 
late is added to the milk, it becomes oil}', and loses flavor. 
Broma is made in the same way. 



DIGESTIVE TRACT. 151 

In the administration of food, it should be remembered that 
a little food at a time, and often repeated, is the general rule for 
sick people. Frequently, where a physician orders beef- tea, or 
something of the kind, the nurse will Xxy to give a cupful every 
three or four hours. Generalh' the patient's stomach rejects it, 
whereas had a tablespoonful been given ever}' half hour or so, it 
would have been retained, digested, and have done the patient the 
intended good. 

SUSTAIN STRENGTH IN THE MORNING. 

The majority of weak patients are unable to take food of 
any solid kind before eleven o'clock in the morning, and before 
that time comes around they are sure to be pretty well exhausted. 
This would not be so apt to occur if a spoonful of beef -tea, of 
wine and arrow-root, of whiskey-punch, or of whatever stimu- 
lant has been ordered by the physician, could be given him every 
hour or two, from the early morning until then. Perhaps by 
noon, or even sooner, he might be able to eat food as substantial, 
as a mutton-chop or piece of nicely broiled beef -steak. If food 
as solid as these can not be taken, of course you will persevere in 
the use of beef- tea, prepared milk, or whatever else the physician 
has ordered. 

BRANDY AND WHISKEY. 

In this connection it may be well to make a few remarks 
about the use of brandy, whiskey, and other stimulants for the 
sick. They are always easily had, and, therefore, oftenest used. 
But where there is any hereditary teiideyicy to the use of such 
things, where the individual has ever shown a disposition to use 
them as a beverage, or where the associations of the person in 
the future may peculiarly expose him to solicitation, none of these 
stimulants, under any consideration, should ever be ordered, 
unless there is absolutely no alternative . This is said because, in 
many instances, substitutes can easily be found by the physician. 

EOOD AT THE BEDSIDE. 

Never leave the patient's food untasted by his side, from meal 
to meal, in the hope that he will eat it. He never does eat it > 



152 DIGESTIVE TRACT. 

and you only add disgust to his distaste by leaving it in sight. 
L,et the food come at the right time, and if it is not eaten, be 
sure to take it away in a little while. 

OVERLOADED PLATE. 
A sick person's plate should never be overloaded with food, 
nor should he ever see or smell the food prepared for others. 
While eating, the patient should be left alone as much as possible. 
Whatever is prepared for the sick must always be of the first 
quality, and cooked with the greatest care. Remember that sick- 
cookery should at least do half the work of the patient's weak 
digestion. 

"drops." 
Always keep your patient's cup and saucer perfectly dry, 
so that no drops of liquid will fall on the sheets, pillow or dress. 
You have no idea what a difference this minute want of care 
makes to the comfort and even willingness of the sick to take 
food. 

WHAT FOOD. 

Common Errors in Regard to Diet. — Beef-Tea. Florence 
Nightingale says, on this subject, that one of the most common 
errors among women in charge of the sick, respecting sick diet, 
is the belief that beef -tea is the most nutritive of all articles. 
"Now, just try," she says, "and boil down a pound of beef 
into beef- tea, evaporate the water, and see what is left of }^our 
beef. You will find that there is barely, a teaspoonful of solid 
nourishment to half a pint of water in beef-tea." There is, 
nevertheless, a certain nutritive value in it, as there is in tea : we 
do not know what. It may safely be given in almost any inflam- 
matory disease, but it should never be alone depended upon, 
especially where much nourishment is needed. 

EGGS OR STEAK. 

Again, it is an ever ready saying " that an egg is equivalent 
to a pound of meat," whereas it is not so at all. Much trouble 



DIGESTIVE TRACT. 153 

lias occurred from this mistaken notion. It is a question whether, 
weight for weight, eggs are equal to beefsteak. Also, it is seldom 
noticed with how many patients, particularly of nervous or 
"bilious temperament, eggs disagree. Most puddings made with 
eggs are distasteful to them in consequence. An egg, whipped 
up with wine, is often the only form in which the}' can take this 
kind of nourishment. 

MILK, BUTTER, CREAM, ETC. 
Milk and the preparations from milk are most important 
articles of food for the sick. Butter is the lightest kind of animal 
fat, and though it wants the sugar and some of the other ele- 
ments which exist in milk, yet it is valuable, both in itself as fat, 
and in enabling the patient to eat more bread. 

albumen. 
The reason of it is just this : Animals require in their food an 
albuminous constituent, a starchy one, and another of fat. The 
first or albuminous (the purest form of which is the white of an 
egg), enters largely into the formation of the human body, the 
muscles being chiefly composed of it. 

SUGAR. 

The second, or starchy component, does not enter into the 
structure of the body as such, but it is converted into sugar during 
digestion, and has much to do with the formation of the tissues 
and heat. 

OILS. 
The oily parts enter largely into the composition of the brain, 
nerves, and, in fact, all other portions of the body, and when 
broken up and consumed, supply a good portion of the fuel for heat 
of the body. 

COMMON SALT, PHOSPHATES, ETC. 

Besides these three mentioned, which are most conspicuous, 
there are other substances, as common salt, phosphates, iron, etc. 
'These are supplied through food, but our space will not permit 



154 DIGESTIVE TRACT. 

more than a mere reference. All food must contain these substan- 
ces in proportionate quantities. If it does not, the appetite craves? 
the one wanted, and if not properly supplied, the part of the body- 
suffers into which the wanting component enters. 

FOOD MUST HAVE IN IT WHAT THE SYSTEM WANTS. 

As all food which properly sustains man must contain these 
principles, it will be readily seen that those vegetable substances 
which are composed of but one of them, or even two, can not 
alone support life. Experience confirms this view. Oils or fat 
are useful as oils or fat, but can not supply the place of starch or 
sugar ; nor can starch or sugar supply the place of albumen or 
flesh. 

VARIETY IX FOOD. 

To obtain all these needful constituents, we must seek a 
variet}^ in our food, and not depend exclusively upon any single 
one for continual use. There are some apparent exceptions to this 
rule, as in the case of milk, which we know is capable, under 
certain circumstances, of sustaining life for a length of time ; but 
the exception is only apparent when we examine into the matter^ 

MILK. 

Milk has these necessary articles in suitable proportion, more 
than an}* other food, perhaps in general use. It has the starchy 
part advanced a step into the shape of sugar, the albuminous part 
as the cheesy constituent, and the fatty as the creamy elements 
Hence, milk might be taken as a sort of representative diet, and 
better adapted to sustain the bod}- in health, or to strengthen it in 
sickness, than any single article of food. But the writer would 
again caution the reader to observe the greatest care in the use of 
milk, whether in health or sickness. It is now an admitted fact 
or truth that cows are subject to tuberculosis or consumption, 
altogether similar to the phthisis of the human kind and numerous 
undeniable instances are on record, where this dread disease was 
conveyed through this source to man and mam^ have fallen- 
victims to the same. Tuberculosis may exist in cattle, when. 



DIGESTIVE TRACT. 155 

outward appearances do not even indicate it, as the following 
clipping from The Philadelphia Record of recent date goes to show : 

"A story of a happening in Yonkers, N. Y., that is now 
going the newspaper rounds deserves more than casual attention. 
Colonel Beecher, who has a residence in Yonkers, in order to pro- 
vide his family with milk of extra quality, bought himself two 
high-priced, registered Jersey cows, and was well satisfied with 
his bargain. Sometime afterward his grandson was taken sick 
without apparent cause. After a while symptoms of tuberculosis 
were developed, and finally there became no doubt of the nature 
of the disease. The child died, and no explanation of the cause 
of his malady could be found. At the suggestion of the physi- 
cian the cows were examined by a veterinary practitioner, who 
pronounced the animals apparently sound, but said they had been 
so well cared for that internal disease might not outwardly mani- 
fest itself. To solve the doubt Colonel Beecher had both animals 
killed and subjected to careful post-mortem examination by experts. 
The result of the autopsy show T ed that the cow t s were tuberculous, 
and left no doubt that the child, who had fed upon their milk, 
had therefrom acquired the disease of which he died. 

This sad tale develops no new danger. It is only an added 
proof of the possibility of tuberculous infection from the milk oi 
cows afflicted with tubercular disease, and of the peril latent in 
using milk even from apparently healthy animals. The extent 
of tubercular infection in cows in some measure explains the 
spread and pertinacity of consumptive disease in this country, 
where milk is a food of general use. Beef, butter and cheese may 
also carry the infective germs. The users of milk may protect 
themselves by boiling it before they use it. Thorough cooking 
is a preventive ; but final and complete relief should be sought in 
the killing of diseased cattle. Necessary inspection and incidental 
expenditure for the preservation of life and health should receive 
the strong support of public opinion." 

HOW TO BOIE MIEK. 

Boiling milk or sterilizing it, as doctors usually call it, is very 
necessary aside from the danger of conveying these germs, especial!}' 



156 DIGESTIVE TRACT. 

in hot weather, or when, from any cause the milk is impure, or in 
cases of existing bowel troubles as it also assists in preserving the 
milk and prevents or delays souring. In hospitals and among the 
wealthier classes an apparatus for boiling milk is used, which is 
called a steriliser but whenever sterilization becomes necessary, 
there is no need for having at hand any elaborate apparatus. The 
milk maj r be simplj* scalded, or heated to, or nearly to, the boiling 
point in a common porcelain vessel ; poured into clean bottles and 
well corked, and so kept for use ; or what, perhaps, is better, put 
into stout, open-necked bottles, subjected then to steam for fifteen 
to twenty minutes, then well corked and kept ready for use when 
wanted. 

Note. — Much is now heard about infant or " baby foods, ' ' or 
patent preparations of food for children, and their merits so much 
lauded b} 7 unscrupulous advertisers, as substitutes for milk, par- 
ticularly in cities and towns, that mothers frequently refuse to suckle 
their infants, or to give them cow's milk, being led astray by these 
deceiving and dazzling advertisements. It is not my object, how- 
ever, to discuss the relative merits of each and every one of these 
preparations, but I will quote what the eminent Professor Wm. 
Pepper writes on the subject, in his valuable work on " Practice 
of Medicine : " — " It is not within the scope of this paper to give 
details with regard to the diet, of either the sick or the well, but 
it seems proper to remark with regard to the feeding of infants, 
more especially in our large cities in the summer months, that all 
the various patent preparations for infant's food are more or less 
pernicious, and should be discountenanced by all medical men. 
The proper food oi an infant is milk — human milk — if it can be had, 
cow's milk, if it cannot. If it be remembered that an infant 
suffers from thirst as well as hunger, and care be taken to give it 
enough cool water to quench this thirst, it will be found that in 
most cases it will thrive on pure cow's milk." 



CHAPTER XVII. 

DIGESTIVE TRACT. 

Our Digestion— Where and How Our Food is Digested and Absorbed into the Blood. The 
Function ot the Digestive Fluids. Dyspepsia and Its Causes. The Proper Diet for 
Dyspeptics. Treatment of Indigestion. Gastralgia or Cramp of the Stomach. An 
Enumeration of the Causes. The Passing of Gall-Stones. Treatment of Cramp. 
Habitual Constipation, Causes and Treatment. 

The process of digestion is a physiological act and is described 
at great length in the medical works treating on that branch of 
Medicine and it is timely, that the laity should better know what, 
when, and how to eat, and at least more fully understand how the 
food is digested and assimilated (taken up into the blood). For 
if digestion were better understood by the people and the laws 
governing the same were properly obeyed, there would very often 
be much less suffering or sickness and consequently exceedingly 
more happiness. A great many people seem to think that the 
act of digestion is wholly performed in the stomach, but such is 
far from the truth. While the stomach serves the purpose of a 
receptacle for the food and performs certain important digestive 
processes, its main function is to soften the food, melt the fats, 
etc. , while by its churning action and by its digestive ferment, the 
gastric juice, it disintegrates muscular and other fibers and trans- 
forms the food mass into a grayish, pulpy liquid resembling pea- 
soup, which is called chyme. This passes the pyloric orifice into 
the small intestine where it is subjected to the action of the 
intestinal juice, the bile, and the pancreatic juice and it is here, 
that the principal part of digestion takes place. The chyme 
coming from the stomach is here converted into a milky liquid 
called chyle and the fats, having now been emulsified and partly 
saponified by the action of the pancreatic juice and bile, the same 



158 DIGESTIVE TRACT. 

is absorbed by the lacteals and thus taken into the blood. This 
then, is the way our food is digested and our bodies nourished. 

I should have remarked that digestion begins in the mouth ; 
the food is masticated by the teeth, moistened and softened by the 
saliva and the starchy elements are converted into sugar. 

DYSPEPSIA OR INDIGESTION. 

The name signifies simply difficult}' of digestion, but con- 
ventional!}', it is applied to cases in which the digestive processes 
are disturbed in various ways, as well as to the cause in which 
their performance appears only to be difficult. The affection is 
of two forms, being acute or chronic in nature. The acute form, 
that is where it has only existed for a few days or a short time, 
and is characterized by weight, fulness or pain in the pit of the 
stomach ; perhaps nausea or vomiting, or after a time looseness 
of the bowels, some heat, pain in the head and general lassitude, 
succeeded by loss of appetite, coating of the tongue, with 
unpleasant taste in the mouth ; is very readily relieved by a mild 
purgative, especially a few grains of calomel in the evening, 
followed by a Seidlitz powder in the morning, and regulated diet 
for a few days, with perhaps, some tonic remedy for a short time. 
But the chronic form must be well understood in order that a 
successful treatment may be obtained. The complaint is so well 
understood and individual cases differ so largely in symptoms, etc. , 
that the writer does not deem it worth the space to describe the 
disease at length, but takes the liberty of merely quoting in part 
— in reference to its management and treatment — from the valuable 
work by the eminent Professor Flint. 

TREATMENT. 

II In the management of dyspepsia, as of other affections, the 
first point is to remove or obviate causes as far as this is practicable. 
The practitioner ma} T be able to control causes relating to dietectic 
errors, but he may not be able to reach those connected with the 
mind, and hence the difficulty in affecting a cure. Measures of 
treatment may be arranged in three divisions, namely : i. Those 



DIGESTIVE TRACT. 159 

relating to diet and regimen ; 2 . Measures addressed to the mind ; 
and, 3. Medicinal remedies. 

1 . If the affection has been induced by dietetic excesses, it 
is sometimes useful to give the digestive organs a short period of 
rest, and, with this view, to reduce the diet, for a time, below 
the wants of the system. This, however, should be but temporal 
A cure is not to be affected by persisting in this course. Not 
only is the system reduced, but the digestive functions are 
impaired by too great or too protracted abstemiousness. Dyspepsia 
is, in fact, perpetuated, and maybe produced, by attempts to live 
on as little and as coarse food as possible. Persons who think it 
vulgar, unrefined, or worldly-minded to eat well, are apt to be 
subjects of dyspepsia as well as of other affections. This is true 
-also of those who fancy that most maladies arise from over-eating, 
and that the great problem of health -preservation is to learn to 
-eat prudently. The object of treatment is to bring the digestive 
powers up to such a point of improvement that particular care in 
diet is not requisite. 

As regards the diet for dyspeptics, there are no rules suited 
to all cases. Individual experience, in each case, is not to be 
altogether ignored, but there is a liability to error in regard to this 
experience. Unusual difficulty of digestion, or indigestion, after 
a meal, is often imputed to certain articles of food, when it was 
due to some other incidental circumstance. Idiosyncrasies in relation 
to particular articles of food are far less common than the statements 
of patients would lead one to suppose. In general, articles which 
are wholesome to most persons are not unwholesome to any. It 
is rarely true that " what is one man's meat is another's poison." 
In most cases animal food is best digested, especially old and tender 
meats plainly but well cooked ; but a milk and farinaceous diet is 
found to aggree best. An obvious reason why so many persons 
imagine they do not digest milk as well is, it is apt to be taken as 
a beverage after or with solids, the fact that it is, in effect, a solid 
article of food not being appreciated. Bread to be readily digest- 
ible, should not be new, nor is it desirable that it should be stale. 
Well boiled rice, corn-meal mush, and other analogous farinaceous 
preparations, are easy of digestion. Crude vegetables are digested. 



160 DIGESTIVE TRACT. 

with more difficulty, but they are not, as a matter of course, to be 
interdicted. Some dyspeptics find even the much abused cucum- 
ber grateful to the stomach as well as to the palate. Pastries, rich 
puddings, and sweetmeats are generally to be eaten sparingly or 
discarded. Ripe fruits in proper moderation are useful. It is 
never advisable for the patient to adopt a restricted range, or any 
particular system of diet. On the contrary, it is important to per- 
severe in attempting to digest all the varied forms of wholesome food, 
not being restricted to meat or a vegetable diet, but aiming to eat like 
persons in health, without the need of particular care in the selection . 
Different kinds of food are suited to different cases according as the 
functional disorder is chiefly gastric or intestinal. If gastric, far- 
inaceous articles will be likely to be best suited, as these are 
digested mainly in the small intestine. Fatty articles may be well 
digested in these cases. On the other hand, if the disorder be 
intestinal, farinaceous and fatty articles of food will be likely to 
be difficult of digestion, and albuminoid substances or an animal 
diet will be found to occasion less inconvenience. Restriction to a 
few meals a da}' is not an uncommon error. If a patient have no 
appetite for breakfast, an early lunch should be taken. If the 
dinner be near the middle of the day, and an early tea be taken, 
some light food in the evening is advisable. Long intervals 
between the periods of taking food tend to weaken the powers of" 
digestion, Food should be eaten slowly. Deliberate mastication 
prepares the food for the action of the gastric juice. Moreover, 
slowness in eating gives the stomach a chance to express satiety, 
and is, therefore, a protection against over-eating. Errors, how- 
ever, in this respect are apt to be over estimated. With regard to 
the use of wine or spirits, the danger of intemperance is always to 
be considered, especially as dyspepsia not infrequently leads to a 
morbid desire for stimulants, and in view of the fact that the men- 
tal state is favorable for the formation of intemperate habits. Yet 
an alcoholic stimulant taken with meals is often useful until the 
normal powers of the digestive organs are restored. Stimulants 
should never be taken when the stomach is empty. It may be 
well to remind the practitioner that it is unphilosophical to judge 
concerning his patients from the conclusions derived from his own 






DIGESTIVE TRACT. 161 

personal experience. The physician who has his notions of what 
kinds of food agree with himself best, is apt to apply these notions 
indiscriminately to his patients. To consider fully the subject ol 
dietetics would be incompatible with the scope of this work ; but, 
practically, this is less desirable than many might suppose. My 
experience has led me to adopt a plan of dietetic treatment which 
has the merit of great simplicity-, and which I have found to be 
very successful. I am accustomed to say to patients that if they 
expect to acquire a good digestion, they must not pay particular 
attention to diet ; that they must follow the dictates of instinct 
rather than an}* precise rules, as respects the articles of food, the 
quantity to be taken, and the time of taking it. I have never 
known a dyspeptic to recover vigorous health who undertook to 
live after a strictly regulated diet, and I have never known of an 
instance of a health}* person living according to a strict dietetic 
system who did not become a dyspeptic. On the other hand, in a 
great number of cases, in which persons had been sufferers for 
years on a regulated diet, health has been speedily regained by 
simply eating in accordance with appetite. 

As regards regimen, the clothing of dyspeptics should be such 
as will secure uniformity of temperature and maintain the functions 
of the skin, without over-accumulation of heat or exciting perspi- 
ration. A sense of comfort is the criterion in this regard. Exercise 
is of importance ; but to be useful, it must be taken with a motive 
and end, aside from the sanitary object. Exercise taken simply as 
exercise, tends to keep the mind of the patient on the disorder, and 
will not be likely to be persisted in. There is a risk of resorting at 
once to over-exercise, a too violent change of habits in this regard 
proving hurtful, and discouraging the patient. The exercise should 
be in the open air. A change of business from one requiring seden- 
tary habits, to one involving out-of-door occupation is often advis- 
able. Travelling, especially in foreign countries where the atten- 
tion is diverted with a succession of novel scenes, is highly useful. 
Sir James Johnston said that no case of purely functional dyspepsia 
could resist a pedestrian tour to the Alps. 2. — The moral treat- 
ment consists first in establishing confidence by attention and 
sympathy. 



162 DIGESTIVE TRACT. 

Inattention to the details into which dyspeptic patients are 
fond of entering, and ridicule of hypochondriacal fears prevent the 
physician from being of service to this unhappy class of patients, 
and lead them to seek for aid from secret remedies and quacks. 
If the confidence of the patient be secured, the assurances of the 
physician will often remove needless apprehensions, and afford an 
encouragement which, in itself, will contribute not a little toward 
improvement. If the patient be convinced that his mental state is 
in a measure due to a disordered condition of the body, he derives 
consolation and encouragement from this belief. The treatment 
relating to the mind will embrace, as far as possible, measures 
having reference to the removal of mental causes which may have 
produced or which perpetuate the affection. It is important to 
incite to occupations which divert the attention from the bodily 
functions, especially during the process of digestion. It is desir- 
able that the mind should be pleasantly occupied. It is often 
observed by dyspeptics that if the}* dine alone, and are left by 
themselves to watch the sensations connected with digestion, they 
are sure to suffer, whereas the}' experience no inconvenience from 
a greater amount of indulgence in eating if they be in agreeable 
company during and after dinner. Popular works on indigestion 
do harm by directing to the subject the attention of those prone to 
dyspepsia. The benefit of travel is, in a great measure, moral, 
involving recreation as well as exercise, and keeping the mind 
occupied with extrinsic subjects. 

The division of the treatment which relates to medicinal reme- 
dies, relatively, is least important, but by no means unim- 
portant. 

When there is much morbid sensibility of the stomach as 
denoted by great and perhaps constant pain in the pit of the 
stomach, small blisters, by mustard, croton oil, etc. , may give 
relief. The benefits, derived by these means, is probably in part 
due to a moral effect. If anaemia be associated, as is frequently 
the case, the preparations of iron, combined with the vegetable 
tonics are indicated ; the tincture of the chloride of iron is perhaps 
the best, and owes its virtues perhaps, greatly to the hydrochloric 
acid which it contains, as this acid exists naturally in the stomach, 



DIGESTIVE TRACT. 163 

it may be combined with equal parts of the tincture of Colombo, 
thus : — 
R 

Tincture Chloride of Iron, one ounce. 

Tincture Colombo, one ounce. 

Dose. 20 to 30 drops in water before meals. 
The following prescription is a very agreeable remedy in 
these cases : 
B 

Tincture Chloride of Iron, one ounce. 

Dilute Phosphoric Acid, one ounce. 

Syrup of Ginger or Orange, two ounces. 

Dose. Half a teaspoonful, in water, before eating, three times 
a day. The citrate of iron and quinine, which can be obtained at 
.any drug store, is an excellent form of tonic in dyspepsia where 
anaemia exists. A two grain quinine pill before meals, and the 
vegetable bitters like the compound tincture of gentian or tincture 
of quassia in teaspoonful doses before meals are of the very best 
stomachics, being tonic and good appetizers. Where habitual con- 
stipation exists laxatives as recommended in treating on that 
complaint should receive proper attention. Salicin, in ten grain 
doses dissolved in a wineglass of water and taken just before 
meals is a capital stomach tonic. The benefit derived from this 
remedy is often remarkable. 

Symptoms characterizing certain cases of dyspepsia claim 
particular remedies, like pyrosis (water brash or heart-burn), 
which is generally relieved by subnitrate of bismuth in doses of 20 
grains, combined with powdered cinnamon, in conjunction with the 
measures relating to diet, regimen, etc. , followed by tonics. Lime- 
water, bicarbonate of soda, carbonate of magnesia, the two latter 
especially if there be constipation are similarly effective. Flatulency 
or gas in the stomach or bowels is to be palliated by carminatives 
(medicines that expel gas) , the aromatic bitters, asafoetida, charcoal 
powder, etc. As this is principal^ caused by intestinal digestion, diet 
which is chiefly digested in the bowels should be avoided as much 
as possible. The tonic remedies recommended before will remove 



164: DIGESTIVE TRACT. 

this annoyance. Small doses of strychnine or nux vomica in the 
form of tincture or extract, are useful in these cases. The writer 
has had great success with the following formula : 

R 

Compound Tincture of Gentian, Y^ pound. 

Diluted Xitro Muriatic Acid, 2 drachms. 

M. Dose. A teaspoonful in water before meals. 

STOMACH CRAMP. 

Gastralgia, or cramp of the stomach, is a neuralgic affection 
characterized by pain, more or less intense, referred to the region 
of the stomach. The affection is very frequently associated with 
d}'speptic disorder ; in short, gastralgia exists when pain and other 
circumstances denote an affection of the same pathological charac- 
ter as neuralgia in other situations. The pain is often very excru- 
ciating, subduing the strongest resolution ; the patient writhes 
and groans with intense suffering. The pain varies much in dif- 
ferent paroxysms or exacerbations (increase in the symptoms of a 
disorder) in the same case. It may have so little intensity as to 
occasion only anno3'ance, or it may be so severe as to give 
rise to extreme suffering. The character of the pain is described 
by patients as burning, lancenating, or gnawing. Frequently 
the pain extends from the immediate region of the stomach 
in different directions, namely, to the back, into the chest, and, 
later alh', into the right and left sides under the small ribs. A 
sense of constriction or compression frequently accompanies the 
pain ; vomiting ma}- take place, but its occurrence is rare, and 
occurring, especially, when indigestible or improper food is the 
cause of the cramp, immediate relief is often obtained. Generals- 
tenderness over the pit of the stomach is wanting, and some 
relief may even be afforded b}' pressure. These attacks are 
generally attributed to spasm or cramp, and the affection 
has been called ' ' colic of the stomach. " It is difficult to 
say how much suffering is due to spasmodic contractions, 
and how much to neuralgic pain. Gastralgia, in some persons, 
is produced by certain articles of food. Strawberries, and other 
articles of food, for example, have been known to prove in this 
way poisonous, and I have met with a patient who had always an 



DIGESTIVE TRACT. 165 

attack after eating honey. These, like other idiosyncrasies or 
peculiarities, are inexplicable. Attacks appear to be sometimes 
attributable to exposure to cold, and to fatigue from over-exercise. 
Gastralgia, or cramp of the stomach resembles gastritis or inflam- 
mation of the stomach, in pain and otherwise, but the immediate 
treatment is the same in all respects. Vomiting may be wanting, 
and, if present, is not as important or prominent a sj'.mptom as in 
inflammation of the stomach. The passage of gallstones or 
hepatic colic offers many symptoms exactly like in this affection 
and the diagnosis is not at once readily made, nor does it matter 
much, in regard to the treatment of pain, as the same is similar, 
as far as that is concerned. Although the suffering is as great as 
in any other affection, there is little or no danger. It may be 
doubted whether this affection, alone, ever proves fatal, and the 
-sufferer may count with great confidence on procuring speedy 
relief by means of the plan of treatment herewith suggested. 
Indeed the affection is one of those which exemplify in so striking 
a manner, the resources of medicine. It is apt to be persisting 
and its permanent cure in different cases, is extremely variable. 
In this respect it resembles other neuralgic affections. It may 
occur at shorter or longer intervals for many months, and it some- 
times persists for many years. As regards prognosis, the worst 
to be apprehended is the protractedness of the affection. It does 
not tend to destroy life either directly or by eventuating in some 
other more serious disease. It is not prudent for a physician, to 
predict that the affection will end speedily, or within any definite 
period ; yet, not infrequently, spells do re-occur, and patients 
remain free from paroxysms all their lives. But in certain cases it 
Is one of the affections most rebellious to therapeutical measures, 
out, as stated in other cases, it is readily amendable to treatment. 
With the affection, in some cases, are associated dyspeptic 
ailments, and in other cases there is no disorder of digestion. 
Paroxysms or exacerbations sometimes appear to be brought 
on or provoked by eating or b} 7 - food in the stomach, but, 
as a rule, relief is felt after eating. The desire for food is oftener 
increased than diminished. Constipation exists much oftener than 
looseness of the bowels. Distension of the stomach or intestines 



166 DIGESTIVE TRACT. 

by gas or wind (flatulency) is sometimes associated. The pulse- 
preserves its normal frequency and the temperature of the body is 
not increased. 

Patients who have suffered from the malady for some time 
are apt to become morose and melancholic. Gastralgia, rarely, if 
ever, occurs under the age of puberty, or in old age. It is 
generally considered that women, much more than men, are liable 
to it, but of 39 cases analyzed by Valliex, only 20 were females. 
It affects those of good constitution and the robust, as well as the- 
feeble and delicate. Persons of sedentary habits are more likely 
to be affected than those engaged in active pursuits. Prolonged 
mental depression has been supposed to favor its occurrence. It. 
appears in some cases to depend on the rheumatic or gouty habit. 
Like neuralgia, in other situations, it may be the effect of malaria. 
Chronic gastritis or inflammation of the mucous membrane lining: 
the stomach, is a frequent cause of the disorder. Finally, causes 
which induce anaemia, or lead to debility, may be more or less 
involved in its production. 

TREATMENT. 

Anodyne remedies are generally indispensible in relieving the 
paroxysms of pain in this affection , chief amongst them is opium. 
Tincture of opium in doses of 30 to 60 drops, or sulphate of mor- 
phine in }l grain doses, (the latter preferable, injected by the 
frypodermic method) at intervals of three quarters of an hour,, 
until the pain is relieved, but in this, as in other painful affections 
which are apt to be persistent, the liability to the formation of a 
habit of using opium is to be considered. Moreover, the con- 
tinued use of opium is objectionable on account of its interference 
with the appetite and digestion, and, in this way, it may contribute 
largely to perpetuate the affection. Sulphuric ether in doses of 
one or two drachms given simultaneously with the opiates named ^ 
not only increases their efficacy, but mitigates their unpleasant- 
after-effects. Subnitrate of bismuth in a drachm dose in combi- 
nation with morphine is a very valuable remedy in these cases. 
Belladonna, hyoscyamus, etc., are good substitutes for opium, or 
where the latter cannot be taken, and are equally good palliatives.. 



DIGESTIVE TRACT. 167 

Opium produces cramp of the stomach in some people, just as it 
will cure it in others. Fomentations in the form of poultices and 
embrocations (liniments) containing opium, aconite, chloroform, 
etc., will sometimes succeed in affording relief. Cold applied to 
the pit of the stomach has been found effectual. Where the cramp 
is caused by overloaded or undigested food, nothing answers better 
than an emetic or vomiting, produced as suggested in another part 
of this book. In cases where the stomach is empty, large quanti- 
ties of hot or warm water drunk in abundance frequently induces 
instantaneous relief. Sometimes cold water is likewise beneficial. 
An alcoholic stimulant, where the pulse is feeble and the surface 
cold is sometimes a useful auxiliary. Rest, regulated diet, and a 
mild cathartic or laxative, provided the bowels do not act, will 
contribute the proper subsequent treatment in an attack of cramp. 
Remedies and measures to improve the digestion when disordered, 
or proper treatment to remove the cause should be employed, after 
an attack of gastralgia in order to avoid subsequent seizures. 
Of curative remedies, quinine in full doses is perhaps the most 
successful. The doses should be sufficiently large to produce the 
physiological effect, that is, buzzing in the ears, etc., which should 
be steadily taken for about two weeks. If, at the end of this time, a 
curative effect be not exerted, it is useless to continue the remedy 
longer. Other remedies, such as large doses of sub-nitrate or 
bismuth, that is, 30 grains, three or five times a day. Tonic doses 
of tincture of nux vomica or sulphate of strychnine and the 
vegetable bitters : quassia, gentian and Colombo, combined with 
the mineral acids, may also be tried. When the trouble is caused 
by gastritis or a catarrhal condition of the stomach, the writer 
has had wonderful results with the following prescription : 
B 

Oxide of Silver, 
Extract of Hyoscyamus, 
Of each 6 grains. 

To be made into 12 pills, dose one pill before each meal. 
Measures of treatment other than the employment of direct cura- 
tive remedies, are of the utmost importance. Change of habits 
from those of sedentary to active life, is of the first importance in 



168 DIGESTIVE TRACT. 

certain cases. The moral influence of recreation, change of scene, 
etc. , is often of more service than medicines. The diet should be 
nutritious, but more or less care should be observed. Alcoholic 
stimulants in moderation with meals ma) T be advised for a time, 
but great care in this respect should be dictated or observed so 
that the person does not become addicted to their use. Tonic 
remedies in most cases continued for a long period, and varied 
from time to time, are advisable. Preparations of iron are 
especially indicated if anaemia be present. In short, dyspeptic 
ailments, which may or may not be co-existing, are to receive 
appropriate treatment and the reader is referred to the article in 
this book in reference to the same. 

HABITUAL CONSTIPATION. — CAUSES AND TREATMENT. 

This affection is so well known that it needs but little de- 
scription. The writer thinks he can not do better than quote 
from Professor Flint's able treatise on Constipatiom in his 
' ' Practice of Medicine. " " The terms constipation and costive- 
ness are commonly used as synonjmis, denoting insufficiency of 
evacuations from the bowels. The latter of the two terms is 
sometimes used to denote a less degree of insufficienc}^ than the 
former, the number of dejections being normal, but the quanthy 
deficient, and the act of defecation labored. Constipation exists 
as a functional disorder, and it is incidental to various affections. 
As a functional disorder it is extremely frequent, and, although 
not a serious affection, it claims attention on account of the in- 
convenience which it occasions, its importance as leading to other 
ailments, and the difficulty often of its removal. The affection is 
seated in the large intestine. The anatomical arrangements of this 
portion of the alimentary canal show it to be intended to serve as 
a temporary depot for fecal matter, thus providing against the 
need of frequent acts of defecation. The contents of the alimentary 
canal are propelled more slowly in the large than in the small 
intestine, first, because the circumference of the former is larger 
in proportion to its muscular power ; seco?id, in the ascending part 
of the colon and of the sigmoid flexure, the contents are propelled 
in opposition to gravitation ; third, the liquid portion of the 



DIGESTIVE TRACT. 169 

contents is absorbed in their passage through the small intestine. 
Experience shows that one free evacuation from the bowels daily 
is the rule in health. But this rule is not without exceptions. 
Some persons have, habitually, two or three evacuations daily, 
and. on the other hand, some have an evacuation regularly every 
second or third day, without any of the inconveniences of consti- 
pation ; in fact, persons of the latter habit are apt to experience 
discomfort if, temporarily, evacuations take place daily. Consti- 
pation gives rise to various local morbid effects, such as a feeling 
of pressure or weight in the perinaeum, a sense of abdominal 
distension or uneasiness, flatulency, diarrhoea, and colic pains. 
Hemorrhoids are often attributed to this affection. It gives rise, 
also, to pain in the head, dullness of the mind, flushing of the face, 
palpitation, and general malaise." 

' ' Various circumstances ma)' contribute to this affection. The 
abdominal muscles play an important part in the act of defecation. 
These muscles become weakened by obesity, and, in females, as a 
result of pregnancy. Deficiency of bile and of the intestinal 
secretions may enter into the causation of some cases. Sedentary 
habits are supposed to favor the affection, but it is probable that 
other causes are more operative, and especially inattention to the 
calls of nature." 

The management of habitual constipation often requires much 
care and perseverance on the part of the physician and patient. 
The object is to secure regular^ and sufficiency in the evacuation. 

The means which may be employed are various. They may 
"be arranged into dietetical, medicinal, and mechanical. The 
dietetical means consists in using freely articles which leave, after 
'digestion, a bulky residuum, namely, cabbage, lettuce, and the 
various vegetables known in this country as greens ; or articles 
having a laxative property, such as molasses, prunes, figs, etc. ; 
<or articles which stimulate or irritate the alimentary canal, 
namely, bran-bread, cornmeal groats, or cracked wheat. This 
•diet will sometimes succeed in obviating habitual constipation. 

The medicinal means are laxative remedies. With regard to 
these, a general rule is, the remedy chosen should be mild, and 
the quantity as small as will suffice for the object. Purgation is 



170 DIGESTIVE TRACT. 

to be avoided. Another general rule may be stated : If more than 
one small dose of laxative be required, the remedy is to be given 
in small doses repeated twice or thrice daily, rather than given in 
a single dose. In this way the object is affected with a less 
amount of medicinal impression, and there is less risk of purgation. 
As regards the particular remedy, aloes are especially suited to the 
desired object. A very small proportion of aloes, a small fraction 
of a grain in each pill will often suffice. Laxative remedies are 
not to' be continued for a longer period than is required to secure 
an habitual action of the bowels. 

The mechanical means consist in the use of enemas and sup- 
positories. The regular use of an injection of cold water, at the 
same hour daily, is a simple and sometimes an effective measure. In 
some cases a suppository of soap answers the purpose of provoking- 
a regular and sufficient evacuation. The cocoa-nut butter may be 
used for this purpose. Common molasses candy answers equally 
well, an oval mass of the size of a pigeon's egg being introduced 
within the rectum. This, however is only a temporary expedient, 
ceasing usually to be effective after a time. The most important 
part of the management in cases of habitual constipation is not- 
embraced in the foregoing measures. One of the most important 
rules is to solicit an evacuation at the same hour daily. Another 
rule, not less important, is never to neglect or postpone the call to 
defecate, when it occurs either after or before the time for the 
habitual performance of the act of defecation. 

By the imperfect and impunctual performance of excretory 
functions, our food becomes our poisons. The lengthened deten- 
tion of faeces in the bowels, like the neglected urine in the bladder, 
begets a host of disorders, in man as well as in woman. Irregular- 
ity or postponement in the evacuations of the body is perhaps the 
most common cause of uterine and pelvic diseases known. For 
not only are local congestions produced mechanically by the 
irritation or the pressure from hardened faeces, and displacements- 
of the womb, brought about by the straining effort to empty the 
bowels, but the whole portal (liver) system becomes deranged. 
Costiveness is the recognized cause not only of hemorrhoids, of 
pelvic and uterine congestions, and of disorders of the digestive,. 



DIGESTIVE TRACT. 171 

but also of faecal poisoning. For if diseases breed from bad 
drainage and defective sewerage without the body, how much 
more from bad drainage and defective sewerage within the body 1 
Excretions retained in the body ferment and decompose ; the 
pestilental gases thus generated, and the products of tissue waste, 
being, resorbed, degrade the blood, disable nerve centers; and 
paralyze the action of vital organs. 



CHAPTER XVIII. 
Pure Air axd Ventilation. 

Pure Air, and Its Effects on Health. Diseases Resulting from Bad Ventilation and 
Impure Air. Bad Air Compared to Soiled Water. Pure Air in the Bed-Room. 
Methods of Ventilation. The Xeed and Uses of Sunshine. The Proper Care of 
School Houses. 

Most persons of average cleanly habits in this country would 
object to being compelled to wear underclothing that had just been 
removed from the bod}' of another man, or to use another person's 
toothbrush, or to eat food that had been partially masticated by 
another. They do not, however, often object to drawing into 
their noses, mouths, and lungs, air that has very recently been 
inside another man's bod}- : and upon the whole it is fortunate 
that they do not, for they cannot very well help doing so under 
the ordinary conditions of civilized life. The evil results of the 
continuous inhalation oi impure air are not in most cases, such as 
to attract notice unless the impurity is very considerable or the 
conditions of moisture and temperature connected with it are such 
as to produce evident discomfort. The injury inflicted on the 
bod}- by breathing air deficient in oxygen and contaminated with 
animal exhalations is usually not perceptible until after a con- 
siderable period of time, and is then often attributed to other 
causes. 

Bad air produces bad health. If you find frosted window- 
panes, damp pillows and walls, and feel languid, with probably a 
slight headache when you wake on a cold morning, you can feel 
pretty sure, that the ventilation is imperfect. In the winter time 
the air is frequently shut out to keep out the cold, and many suffer 
from the ill effects of an insufficient supply of oxygen, and the 
breathing of air charged with carbonic acid and other deleterious 



! 



PURE AIR AND VENTILATION. -W<> 

substances thrown off by exhalation. The evidences of bad venti- 
lation may not be decidedly marked, but the silent and insidious 
injury to health goes on. A family can be comfortable with less 
heat and more fresh air than is generally supposed, and in rooms 
heated by furnaces or stoves, and lighted by gas, too much care 
regarding ventilation cannot be exercised. 

The diseases which are especially produced or aggravated by 
defective ventilation are chronic inflammatory affections of the 
throat and lungs and certain forms of contagious disease, more 
especially typhus fever, diphtheria and phthisis (consumption). 
With regard to phthisis, this is due in part to the fact that the 
probabilities of inhaling the specific bacillus or its spores are 
greater where a number of men or animals are repeatedly breathing 
air containing the dried sputa and other excretions of their com- 
panions, and partly because the inhaling of air loaded with dead 
or dying organic matters tends to accumulate in the air-passages 
materials well suited for the nourishment of the specific germs, 
which in the absence of such food-material would be killed by the 
living tissues with which the}' would come in contact. Ventila- 
tion is the continuous and more or less systematic changing or 
renewal of the air in a room or other enclosed space. To effect it 
the external air must be introduced in a continuous current and 
diffused throughout the room, and a corresponding quantity of air 
must be continuously taken out. 

Perfect ventilation would ensure that a man inhaled no air 
which had recently been in his own lungs or in those of his 
companions. Good ordinary ventilation does not aim at this 
perfection ; it merely ensures that the fresh air comes in in 
sufficiency, and is so thoroughly mixed w T ith the air in the room 
that the products of exhalation and respiration are so diluted 
that when a man having a normal sense of smell comes into the 
room from the outside air he will perceive no unpleasant odor. 
To secure good ventilation in a room it is necessary not only to 
introduce and remove the requisite quantity of air, but to secure a 
thorough distribution and mixing up of the air in the air in the 
room, and to do this without causing draughts which will be 
unpleasant to the occupants. Air has a strong tendency to adhere 



174 PURE AIR AND VENTILATION. 

to surfaces against which a current of it strikes, it does not rebound 
like a billiard ball from a cushion, but spreads out in a thin sheet 
on the surface of the wall, roof, ceiling, or floor against which it 
impringes. If fresh air be introduced through registers in the floor, 
it rises directly to the ceiling, where it spreads out, and gradually 
descends as it becomes chilled. A living man is usually from 
twenty to thirty degrees warmer than the air of his room in 
winter, and therefore acts as a little stove, causing an ascending 
current of air. The air which he exhales is also warmer than the 
surrounding air and rises. Whenever an unpleasant odor is detected , 
you may be certain that there is something in the air which should 
not be there, and if permitted to remain, it may sooner or later be 
attended with evil results. The true means for relief in such a 
case is, removal of the offending cause, whatever it may be. Some- 
times this can not well be done, so we must lessen, as much as 
lies in our power, its tendency to do evil. 

Impure air can no more purify impure soiled blood than soiled 
water can cleanse soiled clothes. There is one thing which can 
do it, and that is, plenty of pure air. A certain quantity of pure 
air added to it, dilutes the bad air and makes it less noxious, while 
if a certain quanthy more is added, the impurity of the air is 
destroyed, as is the case with impure water. Any person can 
judge of this from the good effect of much pure air upon bad air. 
An ordinary man spoils not less than a gallon of pure air every 
minute, this is sixty gallons an hour, or nearly five hundred in 
eight hours. In round numbers, about twenty-five flour barrelfuls 
of pure air are required in a single night for breathing purposes 
alone. 

A great man5 r people have an idea that this letting-in of pure 
air, or "ventilation," means raising a window a little from the 
bottom, or opening a door a short distance. They never mind 
much where the window or door opens into — it is all the same, 
so they open somewhere. The idea is not correct. Ventilation 
as has been said, means providing a means for the pure air to 
come i?i, and for the bad air to get out. This can usually be accomp- 
lished b}^ drawing down the top sash a few inches, which will let 
the heated impure air out of the room, and by raising up the 



PURE AIR AND VENTILATION. 175 

lower sash a few inches to let the fresh air into it. If you wish 
to know that the hot air really goes out at the upper opening, 
sometime hold a lighted candle near it, when the blaze will be 
carried outward by the force of the escaping current; and if you will 
hold it to the opening below, the flame will point inward from 
the current of cool air which comes from without. A more certain 
way to secure the proper amount of fresh air is to have an opening 
on opposite sides of the room, so that the air will circulate through 
the chamber as much as possible. Remember not to have the 
current play over the bed on which a person lies sleeping, as the 
person might catch a cold. But if there is no other way, and some 
rooms are so constructed that no other means appear possible, it is 
better to open the windows, and escape the effects of the ' 'draught, ' ' 
by putting an extra covering over the person. Should there not 
be two windows in the chamber, raise the only one you have and 
open the door a little If no means suggest itself to you by which 
a desirable amount of pure air can be permanently secured, bear 
the matter in mind, and some day, when your physician comes 
in, ask him about it. Persons who habitually sleep in such badly 
ventilated houses are seldom compelled to wait long for an oppor- 
tunity to ask a physician such things, as it is to the occupants of 
these houses that he is most frequently summoned. 

Almost all the fevers, cholera, and other plagues result from 
poisoned air, coming from bad drains, uncleaned streets, and badly 
kept back yards. House slops and remnants of the table, or 
decaying vegatables, should never be allowed to be thrown in the 
back yard. Good drains, clean cellars, and general cleanli- 
ness about the house, are the only safe guards to health. Pure 
air and good ventilation are just as necessay in the house as about 
the house. Whenever a number of persons live together, the 
atmosphere becomes poisoned, unless means are provided for its 
constant change and renovation. The death rate is much greater 
in a crowded tenement house than in the well ventilated and 
regulated homes of the wealthier classes. 

Diphtheria, scarlet fever, and other dreaded contagious dis- 
eases are more prevalent and fatal in our large cities than in the 
country or smaller towns, owing chiefly undoubtedly, to lack of 



176 PURE AIR AND VENTILATION. 

proper drainage, imperfect ventilation and sanitary negligence im 
general, which seems to be so universally the case in towns and 
large cities. The best method of securing an outward flow of the 
foul air is by an open fire. If it is too warm for a fire to be 
desirable, a lamp burning on the hearth is good to create a 
draught. Stoves assist ventilation in the same way as grate-fires, 
though not to the same extent, by drawing off the foul air. A^ 
pan of water should be kept on the stove, to dampen the air by 
its evaporation. Heat without moisture is injurious, a certain 
amount of water}' vapor being essential to the wholesomeness of 
the air. Furnace-heat is especially dry ; radiators are still worse, 
and give no aid to ventilation. 

Always remember that the lungs can not, in any confined 
space, fulfill their office of purifying the blood and removing its 
waste particles unless provision is made for the constant renovation, 
of the air. This can hardly be too much emphasized. There 
are three important rules in regard to ventilation, viz : sufficient 
pure air must be introduced ; the foul air must be removed ;: 
these ends must be achieved without injurious draughts. 
Equally important with pure air in living apartments is 
sunshine. It carries with it radiance and cheer and vigor and 
good health. It is a purifier, warding off mould, moisture, gloom, 
depression, and disease. It should be admitted to every apartment 
of the house, and made welcome at all times. It is a strong pre- 
\entive of the disorders that visit shaded and musty places. It 
brings health and happiness that cannot be obtained from any~ 
other source. It is nature's own health-giving agent, and nothing 
can be substituted for it. It has no artificial counterpart. It does 
not only touch the physical body, but it reaches the mind and soul, 
and purifies the whole existence of man. It may fade a carpet or 
upholstery, but it will bring color to the cheek, light to the eye,, 
and elasticity to the step. The closed and shaded window may 
throw a richness of color upon the room, but it v 7 iil bring paleness 
and feebleness to the occupants. This health agent is free to all,, 
easily obtained, and one of the most economic health preservers 
w 7 e have, and ready to impart its efficacy at the rise of the 
curtain. 



PURE AIR AND VENTILATION. 177 

It is a well known fact that many of our country school houses 
are closed at the end of the regular school term in Spring — shutters 
and doors, wherever sunshine and light are accessible, and all 
particles of good air, thereby excluded all Summer, until Fall when 
school again commences, which is indeed lamentable to relate, but 
much more horrible to realize that the health and life of both 
teacher and scholars become thus jeopardized ! It is timely that 
the public should better understand and more fully, appreciate 
such matters pertaining not only to the welfare of the immediate 
persons in the school room, as such negligence might ultimately 
affect a whole community. School houses should always be 
scrubbed, white- washed, properly ventilated and disinfected before 
occupancy by the scholars. 



*3 



CHAPTER XVIII.— Continued. 
Contagion and Disinfection. 

Microbes in the Water and Atmosphere— Sterilization and Disinfection. What Are Anti- 
septics. Principal Agents Used for Disinfection. How Infectious and Contagious Dis- 
eases are Propogated and Remedied. The Prevention of Scarlet and Typhoid Fevers 
— Diphtheria, Cholera and other Infectious Diseases. How to Disinfect Rooms and 
Cellars. 

It is now an accepted fact that the atmosphere is everywhere 
more or less laden with the minute organisms known as bacteria 
or microbes. These are the lowest forms of animal life. They 
are complex though microscopic and capable of very rapid mul- 
tiplication. 

Sterilization of a substance, or vessel, consists in the killing 
of all living organisms contained in it. This is done by means 
of boiling, baking, or steaming. The application of sterilization 
to the destruction of those bactera or microbes which cause specific 
infections or contagious diseases is called disinfection, and the 
agents used for the purpose are called disi7ifectants or germicides. 
In popular language the word "disinfection" is also applied to 
processes intended to destroy infection if it be present. Thus we 
speak of the disinfection of a privy- vault, or sewage, etc. , and 
there is no special objection to this use of the word, for in the 
majority of cases in which we use disinfectants we do not know 
positively that specific disease producing germs are present, but 
merely think it possible that they may be there. 

Antiseptics are substances which prevent the growth and 
development of micro-organisms, and especially of those which 
cause fermentation or putrefaction or which produce suppur- 
ation. They may or may not be disinfectants or germicides. 
A universal germicide — that is, an agent which affects com- 
plete sterilization — is necessarily an antiseptic for the time 
Deing, but if meat broth be heated until it is sterilized and is 



CONTAGION AND DISINFECTION. 179 

then left in an open vessel, it is not thereby made antiseptic. An 
antiseptic is something which remains, and prevents the develop- 
ments not only of the bacteria present, but of those which may be 
added afterwards, although it does not necessarily kill them. A 
deodorant is an o.g&\\t which destroys or mitigates foul and unpleas- 
ant odors, but many of these agents have little or no disinfectant 
powers. There is no definite relation between foul odors and 
specific disease-producing organisms ; either may be present with- 
out the other, and it is improper to speak of the process of masking 
or destroying the odor produced by a uterine cancer in the last 
stages as being a process of disinfection. 

The principal agents now used for disinfection are heat, 
-carbolic acid, bi-chloride of mercury, chloride of lime, quicklime, 
alcohol, and sulphurous acid. These are the cheapest, the most 
general^ applicable, and the least likely to damage clothing, 
furniture, etc. The strong mineral acids, chloride of zinc, chlorine, 
hypochlorite of soda, and certain coal tar products are also good 
disinfectants, but are only used in special cases. What may be 
-called the natural process of disinfection is accomplished in the 
course of time by light, fresh air, and the action of the common 
bacteria, but for prompt and certain disinfection we must resort 
to other agents. 

Later on w T e will speak of those special disinfectant agents, as 
heat etc., and the simplest method of applying them in many 
cases. 

All infectious diseases are supposed to be propagated by the 
agency of such living particles, given off from the body of the 
sick and conveying the specific poison. They may lie dormant for a 
time, but under suitable conditions develop and multiply, repro- 
ducing the original disease. In some cases the conditions of develop- 
ment are found within the body, and the disease can be directly trans- 
mitted from one person to another, while in others the germ only 
originates in the body, and requires to be developed outside before 
it becomes infectious. Of the latter class are typhoid, yellow 
fever, cholera, dysentery, and the plague, while all the other 
diseases commonly recognized as infectious are capable of direct 
transmission. 



180 CONTAGION AND DISINFECTION. 

After exposure to contagion, some time is required for the 
development of the infectious germs before they actively manifest 
themselves. The interval, during which the poison remains latent, 
is known as the period of incubation. It varies in different 
diseases and even in different cases of the same disease, 
though each has its own characteristic type and mode of 
development. Small-pox is contagious even during the period of 
incubation. In measles and whooping-cough, the risk of infection 
is greatest early in the disease, before the appearance of the 
specific symptoms, rash and whoop. Scarlet fever is not infectious- 
before the throat sjmiptoms are present, and is most dangerously 
so during the third and fourth weeks, when the skin is peeling. 
The poison of typhus appears to exert its influence only within a 
limited range ; contact with the patient must be moderately close 
for infection to take place. But the germs of small-pox, scarlatina, 
or diphtheria may be carried about indefinitely, or lie hidden in a 
room or in clothes for months, and then under suitable conditions 
manifest the greatest virulence. 

Diseases which attack many people at the same time are- 
termed epidemic ; those confined to particular localities are 
endemic. Sporadic cases are such as occur singly, and independ- 
ently of any recognized infectious influence. 

Abundant oxygen is the best disinfectant ; it decomposes the 
septic germs, as it does all other animal organisms. Boiling for 
half an hour will destroy the activity of all known disease germs, 
though in some cases their spores (reproductive cells) have a 
greater resisting power. 

The most important of the special disinfecting agents is heat, 
and the simplest method of applying it in many cases is to burn 
the infected article. The cremation of garbage, of dead animals, 
or of human bodies, is a disinfecting process, though not usually 
performed for that purpose. Dry heat — that is a sort of baking 
in a closed chamber or oven — has been used to a considerable 
extent in many places for the disinfection of clothing, bedding, 
and small movable articles, but it is now being abandoned. It 
penetrates very slowly into non-conducting articles, such as 
bedding, mattresses, and pillows ; it is very difficult to regulate so- 



CONTAGION AND DISINFECTION. 181 

as to secure a proper temperature in all parts of the oven ; it 
fixes stains of blood, excreta, etc., in clothing and bedding so 
that they can not be washed out, and it is very likely to injure 
the texture of woolen stuffs, scorching woolen at about' 250 F. 
Exposure to hot air at 2 20°F. for one hour will kill micrococci 
and bacilli organisms, but not spores, (reproductive cells) which, 
however, may be killed by five hours' exposure to this temperature. 
One hour's exposure to a dry heat of 245 ° F. will kill spores. 
Dry heat is, however, less effective then moist, therefore steaming 
is much surer than baking. The simplest form of application of 
heat, combined with moisture, is by boiling in water, and this is 
the best method of disinfecting all articles of clothing, bedding, 
towels, etc., which can be washed without injury. The ex- 
perience of large laundries connected with hospitals for infec- 
tious diseases, such as that in Glascow, shows that all germs of 
infectious diseases are thus destroyed, and that clothing of small- 
pox, typhus, and other patients may be mingled and go through 
the boiling-vats without risk to the subsequent wearers. It should 
be borne in mind that infected clothing and bedding is chiefly 
dangerous when it is dry. When it is soaked with water it does 
not give off germs to the air. It would often be best, in collecting 
clothing and bedding supposed to be infected, to place the articles 
at once in a cask or tub or other vessel containing cold water, 
partly to soak out any stains and partly to prevent the giving off 
of any dangerous dust. Boiling is also an effectual means of de- 
stroying choleraic, typhoid, or dysenteric germs in water which 
must be used for drinking. 

The best way of disinfecting the air of the sick-room, is by 
ventilating it, that is, by exchanging it for pure air. Air can not 
"be renewed by disinfecting it, any more than it can be disinfected 
by deodorizing. Neither process renders it fit to breathe again. 
In all cases of infectious disease free ventilation is of the first im- 
portance. In those diseases in which (as in scarlet fever and 
small-pox) the infectious particles are largely thrown off by the 
skin, a good deal can be done toward keeping the air pure by 
inunction of the skin with carbolized ointment, and by frequent 
bathing and changing of the clothes. Carbolic crystals exposed 



18U CONTAGION AND DISINFECTION. 

in an open dish, or a carbolic solution sprinkled about the room, 
and on the outer covers of the bed, will quickly correct an 
offensive odor, but neither of these is to be regarded as a 
disinfectant. 

Solutions of sulphate of iron (copperas), nitrate of lead, and 
permanganate of potash, and the various chlorides of lime, soda, 
and zinc, similarly used, do act as true disinfectants, the former 
gradually giving off oxygen and the latter absorbing carbonic 
acid gas and liberating chlorine; but as they affect onfy the air 
coming in contact with them their influence is not far-reaching. 
An\* gaseous disinfectant, (as the fumes of nitrous acid, the 
vapors of iodine and bromine, etc.) to be effective, must be used 
in quantity incompatible with human presence. Chlorine and 
sulphurous-acid gas are the only two commonly employed. The 
most powerful and rapid of the liquid disinfectants in general use 
is the solution of bichloride of mercury (corrosive sublimate.) 
The solution ordinarily used is of the strength of i to 1,000, or 
about fifteen grains to the quart. This ma}* be used for disinfect- 
ing vessels, sinks and drains; but not for clothing, as it makes an 
indelible stain. 

Copperas or chloride of lime may be thrown dry into water 
closets and drains with good effect. They should afterwards be 
thoroughly flushed. A good disinfectant is made by dissolving 
half a drachm of nitrate of lead in a pint of boiling water, then 
dissolve two drachms of common salt in eight or ten quarts of 
water. When both are thoroughly dissolved pour the two mix- 
tures together, and when the sediment has settled you have a pail 
of clear fluid, which is the saturated solution of the chloride of 
lead. A cloth saturated with the liquid and hung in a room will 
at once sweeten a fetid atmosphere; poured down a sink, water 
closet, or drain, or on any decaying or offensive object, it will 
produce the same result. The nitrate of lead is cheap, and a 
pound of it would make several barrels of the disinfectant. 

Typhoid fever and cholera are only indirectly contagious, but 
the greatest care is essential in disinfecting those discharges from 
the body which contain the germs of contagion. Stools must be 
disinfected and disposed of thoroughly and promptly. For stools, 



CONTAGION AND DISINFECTION. 183 

cover the bottom of the receiving vessel with copperas or chloride 
of lime before use. After use, add crude sulphuric acid, in 
quantity equal to one half the bulk of the discharge, cover closely, 
and earn* at once from the room. These stools must not be 
emptied into the common closet. The best way to dispose of them 
is to mix with sawdust and burn them. All clothing and bedding 
soiled even in the slightest degree with the discharges must be 
disinfected with equal care and boiled. These measures rigidly 
taken, will prevent the spread of such diseases, unless there is 
some local cause for it. 

When a patient has died from any infectious diseases the body 
should be washed with some disinfectant. The burial should be as 
soon as possible, and strictly private. 

After the recovery or death of the patient from such a disease 
great care must be taken to thoroughly disinfect the room and 
everything in it. 

To fumigate a room with sulphur, close the doors, windows 
and fire-place, and paste paper closely over all the cracks. Put 
the sulphur in iron pans, allowing two pounds for every thousand 
cubic feet of space. Set the pans in larger pans of water, and 
these on bricks so as not to burn the floor, pour a little alcohol 
over the sulphur and ignite, beginning with the pan farthest from 
the door by which you are to make your exit. Leave the room 
quickly, and paste up this door like the others. Keep it closed 
for twenty-four hours ; then open all the windows, and let the 
room air for as much longer. 

It has been said that the value of sulphur as a disinfectant 
has been exaggerated, but nothing better has been suggested to 
take its place. 

OTHER WAYS TO DEODORIZE A ROOM. 

Coffee pounded in a mortar, or otherwise, and roasted on an 
iron plate ; sugar burned on hot coals ; and vinegar boiled with 
myrrh and sprinkled on the floor and furniture of a sick-room, are 
all excellent deodorizers. 



CHAPTER XVIII.— Concluded. 

Home Nursing and Care of the Sick. 

In nursing, like in a great many other matters it is very often 
the small things that insure success. It is remarkable to notice 
the difference in the conduct of people, particularly in emergencies 
when the right thing must be done at the right moment with no 
time to spare for reflection. Some people are peculiarly gifted 
with presence of mind, and are never at a loss as to the proper 
thing to do, while others are "completely at sea," and if they 
act at all it is to do the wrong thing. 

Some appear dazed and allow the time for action to be lost, or 
by crying and wringing of hands add confusion to the excitement. 
In such cases as these "knowledge is power" indeed, and self- 
control very desirable. The nurse or attendant must learn to be 
cool and collected in time of trouble. 

Good or proper nursing can scarcely be over-estimated. In 
many cases the recover}' of the patient will depend more upon the 
care he receives than upon medical skill. Nursing, properly 
includes the administration of food or medicines, the execution of 
the physician's orders as well as the more personal care of the 
patient, such as attention to the condition of the sick-room — its 
warmth, cleanliness and ventilation. The careful observation and 
reporting of s3^mptoms and the preventing of contagion as per 
disinfection of the passages and disinfectant ablutions in scarlatina 
and other like contagious affections. Nursing the sick is a work 
which falls largely, though not exclusively, to the share of women, 
and it has sometimes been claimed that all women make good 
nurses, simply b} T virtue of their womanhood, but this is far from 
being true. To fitly fill such a position as nursing requires 
certain physical and mental attributes, which all women — even 



HOME NURSING AND CARE OF THE SICK. 185 

all good women — do not possess, as well as some special training. 
In this connection, it may be remarked that a woman if ever so 
well intended and qualified otherwise, if she lacks the executive 
ability, is unfitted for a first-class nurse. 

Any expression of alarm or anxiety at a critical moment may 
result disastrously to the patient. If persons have not the power 
of self-control, I advise them to avoid placing themselves in 
positions where the same is necessary. As far as circumstances 
admit, it should be made a duty of one person to care for a 
particular case, as there is less liability^ of confusion in taking orders 
and giving medicine when one has entire charge. It is also better 
for the patient, for he soon learns to trust to the attendant's 
judgement and throws off all the care or personal responsibility. 
Confidence in the nurse is a great point in managing very sick 
patiens, as it is very trying to the sick to feel that they must keep 
track of the food, medicines, etc. 

Cheerfulness is another very desirable quality. It inspires 
hope and confidence, thus materially aiding recovery. Everything 
of a desponding nature should be kept out of the sick-room. It 
would be hard to estimate the influence of the sad-eyed friend who 
would come to the bedside of a very sick patient and ask him if 
he was " prepared for the worst." 

Everybody has a prejudice in favor of some particular 
physician or line of treatment, but it is not everybody who has 
sense enough to keep it to himself. For how often do we hear 
such expressions in the presence of the sick like the following: "If 
3-ou would only have Dr. So and So, and take such and such a 
medicine you would not have to lie here and suffer, etc. etc. , " as is 
a fair sample of the advice such would-be friends often give. At 
the same time the}^ forget their own ignorance as to the nature of 
the case or means of cure being employed. How often we hear such 
remarks as "well he is simply committing suicide by sticking to 
that physician" or equally unkind remarks, regardless of truth or 
of the feelings of the friends of the family or its effects upon 
the patient. Everything of that nature should be kept from the 
patient, even if it becomes necessary to bar the doors against such 
intruders. By way of parenthesis, I would advice that you employ 



186 HOME NURSING AND CARE OF THE SICK. 

only that physician in whom you can have explicit faith and 
confidence, and then stand by him. He is better able to judge 
of the course of disease and its probabilities than one who would 
be called in at a crisis. No one, I think, cares very much to do 
anything for anybody if the person thinks he or she is not doing 
it right or properly, or seems to think some one else could do 
more or perhaps do it better, and it is very annoying and distress- 
ing to any one to be obliged to work under such circumstances, 
and to no one can such treatment be more unpleasant than to an 
attending physician, especially in case of a protracted sickness. 

Unnecessary noise and confusion should not be permitted in 
the sick-room, nothing is more irritating to a nervous patient than 
loud talking. When it is necessary to converse with the sick let 
the voice be sufficiently loud and clear to enable the hearer to 
understand without special effort. Talking other than necessary 
to ascertain the condition or wants of the patient should not be 
allowed. Remember that the nurse is not present to entertain but 
to aid the patient. 

Whispering or low talking is very annoying, and it is apt to- 
arouse a feeling of apprehension in the patient. He feels that 
something is being kept from him, and he will exercise every 
power, both mental and physical, to ascertain what it is. 

In bedside watching, the nurse's work is often very respon- 
sible and trying, and it is here that the observing physician can. 
readily determine whether the nurse is experienced or not from 
her general bearing. It is easy for the nurse to fall into the habit 
of fussing. Annoying the patient by over-attention is often as- 
bad as the crime of omission. 

The nurse must be systematic, gentle and cheerful, but firm 
and active. Observe with care the directions of the physician and 
be sure that they are understood. Do not fall into the habit of 
advising the physician as to the proper course to be pursued in_ 
managing the case. While it may amuse the physician, it is often- 
very annoying, and it is liable to lead to confusion. At any rate,, 
the nurse is not warranted in assuming responsibility in the treat- 
ment. The nurse must provide for her own health and comfort 
too by securing time for meals, sleep and exercise. If required to 



HOME NURSING AND CARK OF THE SICK. 187 

sit up nights it is well to provide a midnight meal of nutritious 
food. 

All arrangements for the night should be made beforehand. 
Extra bedclothes should be at hand. Fuel should be provided and 
so arranged as to be used without noise. Coal may be noiselessly 
placed on the fire if the precaution has been taken to have it put 
in paper bags read}' for use ; the bag of coal being laid on the fire, 
and the coal spread about as it begins to burn. The temperature 
of the sick-room should be kept at about 65 degrees. In the early 
morning hours the vital forces of the patient are at an ebb and it 
is often necessary to add additional clothing or provide something 
stimulating at this time. 

A nurse should never allow herself to become impatient. A 
sick person is often irritable and sometimes obstinate, but this 
must be overcome by kindness and firmness. Do not omit any 
little attention that will add to the comfort of the sick, If turning 
the pillows, or a sip of water, or brushing the teeth with a soft 
cloth moistened with lemon- water please the patient, do it by all 
means. 

In so small a thing as giving the patient a drink of water it is 
often necessary to resort to strategem to satisfy him. Unless the 
patient be allowed all he desires, regulate the quantity before hand- 
ing it to him ; if he is allowed to drain the glass, he is usually 
satisfied and will ask no questions. Avoid jarring the bed and do 
not allow any one to sit on the bed. 

Avoid haste ; do things quickly by knowing what to do and 
how to do them. All appearance of haste and uncertainty is 
annoying to the sick person, and above all things do not forget 
that kindness and tenderness are essential in successful nursing. 
This may seem like dwelling at length upon what might be termed 
minor points in nursing ; but in reality they stand first in import- 
ance because they are so often overlooked, and in many cases, 
especially in a tedious convalesence thoughtful care in regard to 
these small details will keep the patient contented and happy, and 
make his recovery more rapid, than will greater experience on the 
part of the nurse, without these desirable characteristics. 



CHAPTER XIX. 



DISEASES OF CHILDREN. 

Part i. — Intestinal Worms in Children. They Ma3^ Cause Serious Sickness and Death. 
Six Kinds of Worms. The Symptoms They Produce. The Causes of Worms. How 
to Recognize the Presence of Worms. How to Successfully Treat Them. Improper 
Worm Mixtures Frequently Do Harm. TapeWorms— Their Prevention and Removal. 

Part ii. — Nightmare, or Night Terrors of Children. 

Part hi.— The Mother's Medicine Box of Home Remedies. 

Part iv. — Cholera Infantum. Complete Instructions as to Preveniion. Causes and 
Treatment. 

Part v. — The Care of Infants During Hot Weather. Home Treatment of Colic. Con- 
stipation. Convulsions or l> Fits " in Children — Causes and Treatment. 

Part vi.— Laryngitis or Croup of Children. 

Part vii. — Whooping Cough. 

Part viii. — Chorea or "St. Vitus Dance." 

PART I. 

The belief among doctors that the presence of worms in the 
intestines constitutes a frequent disease in early life is now 
generally abandoned, since the patholog}^ of infancy and child- 
hood, and especially the means of recognizing diseases are better 
understood by the profession. Still intestinal worms must be 
considered an occasional cause of serious derangement, or even 
disease, and of death also. There are six kinds of worms whose 
dwelling is the human intestines : namely, the large round worm, 
found in the small intestines, especially of ill-fed children ; which 
somewhat resembles in size the common earth-worm. It varies 
in length from six to nine inches and is of a light yellow color. 
The symptoms which it may possibty give rise to, are first, dis- 
turbed sleep, with grinding of the teeth, pallid countenance, 
dilated pupils, bluish rings beneath the eyelids, foul breath, swelled 



f 



DISEASES OF CHILDREN. 189 

belly, wasted extremeties, depraved appetite, slimy stools, itching 
of the nose straining at stool and itching of the anus ; second, 
the small thread worm found in the rectum which is the smallest 
of the intestinal worms, averaging usually about a quarter of an 
inch in length and is white in color. It gives rise to intolerable 
itching and irritation about the anus, straining at stool, picking 
of the nose, disturbed sleep, and sometimes convulsions. Third, 
the long thread worm usually found in the caecum and large 
intestines, about 8 or 10 feet from the anus, measuring about 
2 inches in length, and having a very slender body. It is often 
found in considerable numbers even in the intestines of healthy 
persons : during life they give rise to no symptoms. Fourth,, 
the common tapeworm of this country called the Taenia Solium,, 
which exists in the small intestines, varying in length from 
5 to 35 feet. The symptoms of its presence are not very 
striking, its existence being generally unsuspected until single 
joints are passed in the stools, in many cases, however, 
there is a continual craving for food, debility, pain in stomach,, 
wasting of flesh and itching about the nose and anus. Fifth, 
the broad tapeworm which is almost peculiar to the inhabi- 
tants of Switzerland, Russia and Poland. There is no certain or 
infallible sign or s3 r mptom of worms excepting actually seeing the 
worms. But microscopic investigations have revealed a definite 
sign namely the presence of ova or eggs in the passages from the 
bowels. By these means the nature of the disease as well as the 
species of worm may be ascertained. Sixth, the Taenia Saginata, 
another species of tapew r orm. Tapeworms are very rare in early 
life. Most practitioners never meet a case of it in children ; still, 
there are such cases on record. Worms are much more common 
among the children of the poor than those in the better walks of 
life ; the same applies to locality. Among the causes of worms 
in the alimentary canal may be mentioned continued indigestion, 
inferior quality, and poorly prepared food. It is also a common, 
and probably correct belief that the use of certain kinds of food, 
favors the development of worms. Fruits in excess, and sweet 
substances, taken in too large a quantity or too frequently. Both 
the round and the thread worms occur oftenest in children , between 



190 DISEASES OF CHILDREN. 

the ages of three and ten years. The freedom from worms is 
greatest in those children who are nourished entirely, or almost 
entirely at the breast. I would remark here, while these worms 
usually reside in the small intestines, the long or round worm 
occasionally enters the stomach from which it is vomited. Cases 
are on record, in which the worm entered the windpipe, producing 
suffocation and speedy death. It has been discovered in the 
vermiform appendix, in the pancreatic duct, the common bile 
duct, and even in the gall-bladder. Under such circumstances 
serious results are likely to follow. The s}-mptoms and disorders 
produced by worms may all occur from other causes, Much 
injur) 7 has been done to children by the use of worm medicines, 
occasionally employed by physicians, but oftener b} T parents, before 
the physician is called. Medicines of this class are usually irritants, 
and, as in many of those diseases which simulate the verminous 
affection, but are distinct from it, there is already an irritated, if 
not an inflamed state of the intestinal mucous surface. Vermifuge 
administered under such circumstances, obviously do harm, and 
in all acute diseases in which they are not required, even if their 
action is harmless their employment is to be regretted since it 
consumes time which is often very precious. 

It is thus that many lives are lost by the use of worm 
mixtures which are extensively advertised and which command 
a ready sale, since the belief in the existence of worms as a fre- 
quent cause of disease, pervades all classes of the community. 
A safe rule, followed by many plrysicians, and it would be much 
better if it were general, is not to give worm medicines unless the 
•child has passed one or more worms, or their eggs, are found in 
stools and not then if all the symptoms seem to be referable to 
existing disease. In doubtful cases, in which the symptoms 
resemble those of worms, a purgative dose of calomel, or calomel 
and rhubarb may be employed. It will generally bring away one or 
more roundworms or a mass of thread worms, if either species of 
worms is present. This ma} T be safely employed if there is no 
previous diarrhoea or debility. If after one or two doses, and a 
free purging no worms are passed, worm-remedies should not be 
given, for it is almost certain that no worms exist. 



DISEASES OF CHILDREN. 191 



Part I. 



TREATMENT. 



A large number of medicines have or have had a reputation 
against worms. Santonin, the active principle of the European 
wonnseed is one of the best, aud is much employed in this 
-country and in Europe. It is nearly tasteless ; it may be given 
in powder in two or three grain doses, three or four times a day 
in sugar, or spread on bread with the butter. It is kept in the 
shops, in one or two grain lozenges, sometimes mixed with 
■calomel. If it fails to purge or physic the last dose should be 
followed with a dose of castor oil. It has the advantage of easy 
administration and is destructive to both the round and thread 
worm. The purgative is required to aid, not only the expulsion 
of the worm, but also of the eggs. There are many other worm 
medicines but these generally suffice and I deem it useless to 
enumerate the many worm-mixtures which have been extolled 
from time to time. To remove a tapeworm, let the child fast for 
about a day, give a purgative dose of calomel and male-fern, or 
what is perhaps better in children pumpkin-seed (the inner portion) , 
in sufficient quantities for a da}^, and followed again by a brisk 
cathartic. Threadworms require different treatment. The an- 
thelmintics described above have less effect on them than on the 
lumbrici. Still, they may be administered for the expulsion of 
the former, but rather as adjuvants to the main treatment. The 
maint reatment should be local, consisting in the use of injections, 
since from the habitat of this worm enemata (injections), will 
ordinarily reach and destroy it. The substances which have been 
successfully employed as enemata are salt and water, lime water, a 
decoction of aloes, or a decoction of two cloves of garlic in milk 
and quassia. The injection of six ounces of lime water and two 
drachms of tincture of chloride of iron has also been highly extolled. 

Threadworms in the rectum may also be destroyed by oint- 
ments containing mercury, as a drachm of mercurial ointment 
mixed with oil or melted butter, or five grains of calomel with 
yolk of an egg. Suppositories containing santonin are likewise 
very efficacious for this purpose. 



192 DISEASES OF CHILDREN. 

Note. — Tapeworms are caused by eating either raw beef or 
pork, or meat and fish not thoroughly cooked, which frequently 
contain the so called cysticerci (the larval form of the tapeworm). 
In view of the danger of acquiring a tapeworm, it is certainly not 
judicious to use raw beef or pork or partly cooked meats and fish, 
as articles of diet. The meat contained in bologna sausages is 
liable to contain living parasites of this form and kind, and there- 
is danger from this source from eating the same. 



Part II. 

NIGHTMARE OR NIGHT TERRORS OF CHILDREN. 

A young child may go to bed quite w T ell, fall asleep, but after 
sleeping two or three hours, or perhaps in the middle of the night, 
it suddenly awakens in great alarm and utters loud cries ; its 
attention seems absorbed by some frightful dream — probably about 
a bear or a dog, or some other animal w T hich is thought to be in 
the bed and for a few moments it fails to recognize its nurse or 
parents w 7 ho have been attracted by the noise. After having been 
soothed and taken into the arms of its mother or nurse it weeps 
and sobs, then gradually grows quiet and again falls asleep ; and 
probably the attack does not return until one or more nights after- 
wards. Seizures of this kind are generally due to disorders of the 
stomach or bowels, producing sympathetic irritation in the brain 
or nervous centre. Worms in the intestinal canal as well as an 
over- loaded stomach or indigested food may produce night- 
mare. These cases are readily curable, the grand point is to regu- 
late the action of the stomach and bow r els and relieve the constipa- 
tion which generally exists, especially if the diet be at the same 
time, rendered simple, nourishing, and digestible. The child's 
bed ought also to be placed by the side of its parent's bed. The 
child should not be left alone, and a candle should be kept burning 
in its room all night and great kindness should be shown when it 
awakens with this mental torture. To relieve the habitual consti- 
pation and improve the digestion nothing is better than the follow- 
ing prescription : 



DISEASES OF CHILDREN. 193 

R 

Comp. Tinct. Gentian, one ounce. 

Fid. Ext. Caseara Segrada, one ounce. 

Water, two ounces. 

Mix. Give a teaspoonful, more or less according to the age 
of the child, before each meal. Regulate the dose according to 
the condition of the bowels. 

Nightmare in grown persons does not differ materially from 
the nightmare of children just described, and is likewise attribu- 
table to the same sources. It also readily admits of a cure by 
following the directions of treatment suggested in the chapters on 
Dyspepsia and Habitual Constipation. 

cholera' morbus. 

Nearly ever}' one knows what cholera morbus is, and it is 
not deemed necessary to go into a lengthy description of it. It is 
characterized by intense vomiting with pain in the stomach and 
water}' diarrhoea, often accompanied with cramps in the legs and 
arms. It occurs most frequently in the summer or autumn and is 
usually caused by improper food, especially unripe fruit. An 
attack of cholera morbus often comes on suddenly, sometimes there 
is a sense of weight or uneasiness for a few hours in the stomach, 
extending more or less over the abdomen, with perhaps colicy 
pains before the seizure. The attack takes place much oftener in 
the night than in the day-time and commences by vomiting and 
purging, the same occurringin quick succession or simultaneously, 
and these latter are the chief features of the affection. The evacu- 
ations from the stomach and bowels are generally abundant, and 
accompanied with great pain, very like that of cramp or spasm of 
the stomach. Death from this affection in the grown person is 
extremely rare, but on the contrary recovery, is usually speedy. 
It occurs much oftener in men than in women. 

The treatment of cholera morbus consists in relieving the 
excruciating pain by opiates (morphine, laudanum, etc.,) either 
administered by mouth or hypodermatically (under the skin), as 
suggested in cramp of the stomach. The opiates will, in most 

14 



194 



DISEASES OF CHILDREN. 



cases, check the diarrhoea, as well as the vomiting and pain. If 
the morphine, etc., are vomited, a second dose should immediately 
be given and continued until the dose is retained. No liquids 
whatever if possible, should be given. The intense thirst which 
usually exists may be quenched by a tablespoonful of ice water at 
short intervals, or what is better, small pieces of ice may be taken 
frequently and allowed to melt in the mouth. If there be great 
exhaustion, a little whiskey and water may be taken, if retained, 
at short intervals. Care as regards diet is alone required in most 
cases, after an attack of cholera morbus. 



Part III. 

the mother's medicine box of home remedies. 

livery mother should keep on hand simple remedies, for it 
may often save the life of a member of the family. Keep the bot- 
tles well corked and labeled, and all medicines in safe quarters. It 
is better to have small bottles and fill them frequently, if neces- 
sary, as many medicines lose their strength by keeping. 

Castor Oil. — This is the safest laxative for children, and half 
a teaspoonful may be safely given to a child under a year old, and 
two to a child of six. Give in case of vomiting and diarrhoea from 
undigested food. 

Sweet Spirits of Nitre, will reduce fever and produce per- 
spiration. Put two teaspoonfuls in a half glass of cold water, and 
let the child take a teaspoonful at intervals of half an hour. This 
is also excellent in colds and may be combined with paregoric for 
the latter purpose. 

Syrup of Ipecac, is a good emetic. Give a teaspoonful to a 
child over one year of age, and follow this by giving the child 
tepid water until copious and free vomiting is produced. This is 
one of the best remedies for croup. 

Iodine. — In case of slight soreness of the chest, or enlarged 
-gland in the neck or groin, apply with a camel's hair brush. If 
the skin is tender, one application will be sufficient. If it smarts 
too severely, it may be washed off with ammonia. Ordinary starch, 



DISEASES OF CHILDREN. 195 

wet and applied in a paste over the part on which the iodine is 
painted will, if allowed to dry — subdue the smarting. 

Camphorated Oil. — This is the best application for cold in the 
chest. Warm the oil and rub the back and chest well with it. 

Liniment. — Every mother should keep on hand a bottle of 
good arnica or some other well recommended liniment found in 
other parts of this book. 

Aromatic Spirits of Ammonia. — Ten or twelve drops may be 
given in water to a baby that suffers continually with colic. A 
half teaspoonful will relieve cramps in other children. Keep in a 
bottle with a glass stopper. 

Lime Water. — A quart bottle of this may always be kept on 
hand as it does not easily spoil. 

Powdered A turn. — Half a teaspoonful of powdered alum mixed 
w T ith a little sugar is an excellent emetic, if the first dose of ipecac 
is not effectual. It is good for canker sores of the mouth, and 
an excellent remedy for nose bleeding if sniffed up the nostrils. 

Glycerine. — Half tablespoonful doses relieve the irritation of 
the throat caused by coughing. Mixed with powdered tannic acid 
and diluted with water, it is a good gargle for a sore throat. 
Mixed with four or five times as much rose water it makes a heal- 
ing wash for chapped hands, rough face, or chafed skin. 

Bicarbonate of Soda, or the ordinary baking powder is also a 
good household remedy and should always be kept on hand. A 
teaspoonful in half a cup of water will readily relieve water brash 
or heartburn. Dusted on burns or in solution applied on rags to 
scalds or burns as directed in another part of this book, forms one 
of the best home remedies in the treatment of these accidents, that 
can be advised. It is a ready antidote for carbolic acid and the 
other acid poisons. Bicarbonate of soda is largely used by phys- 
icians to render the urine alkaline in inflammatory rheumatism. 

Paregoric. — A good household remedy and should be kept in 
every family ; given in doses of five to twenty drops or more 
according to the age of the child, it is a capital remedy for pain of 
a colicy nature and timely given will often check diarrhoea, thus 
frequently preventing cholera infantum, or serious consequences. 

Carron Oil, consists of equal parts of lime water and linseed 



196 DISEASES OF CHILDREN. 

oil ; is the remedy par excellence for burns or scalds when applied 
according to directions given in another part of this volume. 

Prepared Chalk, which costs about twenty cents a pound 
should always be kept on hand. Aside from its being a rather 
valuable antidote in carbolic, and the other acid poisons, it is also 
excellent in water brash, heartburn or acidity of the stomach, and 
the acid or green movements of babies and children and in adults. It 
can be administered in unlimited quantity as it is perfectly harmless. 
Bromide of Potassium, should be included in the list of 
domestic remedies. It is of much benefit in convulsions of children ; 
in sick headache ; insomnia, etc. It can be administered in large 
doses for these purposes. It being quite harmless. It is cheap 
and does not spoil by being kept. 

Lime Water. — A large bottle of this easily prepared com- 
pound should always be kept prepared for use. It is not only 
desirable as an antidote to many persons, as carbolic and oxalic 
acids, but it is a valuable antacid, when such a thing is required. 
To make it, tak^ a piece of unslacked lime (never mind the 
size, because the water will only take up a certain quantity) ; put 
it into a perfectly clean bottle and fill the bottle up with cold water ;: 
keep the bottle corked, and in a cool, dark place, such as a cellar. 
In a few minutes it is ready for use, and the clear lime water can 
be poured off whenever it is needed . When the water is exhausted , 
fill the bottle again. This may be done three or four times, after 
which some new lime must be used, as in the beginning. 

Among the other domestic remedies, always safe in the hands 
of the layity which should be kept among the household remedies,, 
may be mentioned. 

Ground Mustard, Chlorate of Potash, 

Sulphuric Ether, Brown's Mixture for Cough, 

White Vitriol, Vaseline and Cosmoline, 

Spirits of Hartshorn, Sweet Spirits of Nitre, 

Liver Pills, Essence of Ginger, 

Calcined Magnesia, Tincture of Arnica, 

Essence of Peppermint, Carbolic Acid, (labelled poison). 

Cox's Hive Syrup, Chloride of Lime, for disinfecting. 

Compound Cathartic Pills, Tincture of Opium, (in case of 

pain — carefully labelled. ) 



DISEASES OF CHILDREN. 197 

Part IV. 

CHOLERA INFANTUM. 
Complete Instruction as to Prevention, Causes and Treatment. 

Cholera infantum is a disease of the summer months and 
occurs in young children. It is usually due to improper food, 
teething and unhygienic surroundings, such as want of ventilation 
and sunshine, improper food, uncleanness, etc. Cases occur from the 
month of May to October. It is most frequent in large cities and 
towns and is more common in tenement houses, and parts of the 
city or town occupied by the poor, than in cleanly and less crowded 
streets and apartments. Summer heat and the anti-hygienic con- 
ditions to which it gives rise, sometimes appear to be sufficient in 
themselves to develop cholera infantum. Often in the hot months 
acid and indigestible fruits as currants, unripe apples, etc., heed- 
lessly given to an infant are apt to occasion the attack. It usually 
occurs in children under two years of age. It is so frequent during 
teething that some writers deem it the cause. Some physicians 
designate (as cholera infantum) all infantile diarrhoeas, if they are 
in the least protracted or obstinate in treatment. This is wrong ; 
it should, in my opinion, only be employed to designate that form 
of diarrhoea in children, in which there are frequent, watery, per- 
haps mucous stools accompanied by vomiting and rapid and great 
wasting away of the child. Cholera infantum is a very serious 
disease ; the death rate in cities, towns, and under favorable con- 
ditions, elsewhere, is very large, and it is timely that parents 
should understand more about the cause, prevention, and treatment 
of it. 

Cholera infantum sometimes begins abruptly, like cholera 
morbus, in the adult ; but in my experience the affection is often 
preceded by a premonitory stage, that of simple diarrhoea, the 
passages of which are thinner than natural, and somewhat more 
frequent, but not such as to excite alarm. Suddenly the evacua- 
of tions become more frequent and watery and the parents become 
surprised and frightened by the rapid sinking and real danger the 
infant or child. Occasionally this antecedent diarrhoea has continu- 
ed several weeks, attended with emaciation and associated, perhaps, 



198 DISEASES OF CHILDREN. 

with inflammation of the bowels. In other instances the previous 
health has been good and cholera infantum commences suddenly, 
that is, the child is seized with intense vomiting and diarrhoea all 
at a sudden. The disease is characterized by the discharge from 
the bowels of thin stools, designated by some watery, by others 
serous (whey like). The first evacuations, unless there has been 
previous diarrhoea, contain considerable f cecal matter. They are so 
thin as to soak into the diaper almost like urine, and in some cases 
they scarcely produce more of a stain than does this secretion. The 
odor is peculiar, not f cecal, but musty and offensive ; occasionally 
the stools are almost odorless. Commencing simultaneously with 
the water} 7 evacuations, or soon after, is another symptom, namely 
irritability of the stomach, which increases greatly the prostration 
and danger. Whatever is swallowed by the child is rejected 
immediately or in a few minutes, or there may be retching without 
vomiting. The appetite is lost, and the thirst is intense. Cold 
water, especially, is taken with avidity, and if the infant nurses, 
it eagerly seizes the breast, evidently to relieve the thirst. The 
tongue is moist at first, and clean or covered vvith a light fur. 
The pulse is accelerated, while the respirations are either natural or 
somewhat increased in frequency ; the surface is warm, but its 
temperature is speedily reduced. There is no abdominal tender- 
ness, and no evidence of pain. The infant is often restless at first, 
but its restlessness is due to thirst, or that unpleasant sensation 
which the sick experience when the vital powers are rapidly 
reduced. The urine is .scanty in proportion to the gravity of the 
attack. The loss of strength, and the emaciation are more rapid 
than in any other malady. The parents scarcely recognize in the 
changed and melancholy aspect of the infant any resemblance to 
the features which it exhibited a day or two before. The eyes are 
sunken, the eyelids and lips are permanently open from the loss of 
muscular strength, and the loss of the fluids and of the flesh is 
such that the bony angles become more prominent, and the skin in 
places lies in folds. As the disease approaches a fatal termination, 
which often occurs in two or three days, the child remains quiet, 
not disturbed even by the flies which alight upon its face. The 
limbs and cheeks become cool ; the eyes bleared and pupils con- 



DISEASES OF CHILDREN. 199 

tracted. A state of stupor results from which there is no relief 
and which after a few hours ends in death. Often, even in cases 
which are ultimately fatal, there is not such a speedy termination 
of the disease. The affection may end in an inflammation of both 
the small and large intestines and become very protracted and 
obstinate. In the most favorable cases of cholera infantum the 
patient recovers before this bad condition supervenes. 

TREATMENT. 

The great frequency and water) 7 character of the stools in 
cholera infantum and the rapid sinking of the infant, makes the call 
for prompt measures for the arrest of the disease. Where there is 
suspicion of any irritating substance in the stomach or intestines, 
which might act as an exciting cause of the vomiting or diarrhoea, 
or at least, aggravate them, it is proper to commence the treatment 
by the use of a mild emetic or cathartic. In the majority of cases 
the spontaneous efforts of the stomach suffice to empty the same 
completely, and an agent to provoke vomiting is found unnecessary. 
Whenever it is deemed necessary to give an emetic, two to four 
grains of powdered ipecacuanha, in a single dose, (according to 
the age of the child) is perfectly safe and efficient to throw off the 
load which the child has been imprudently permitted to take into 
the stomach. It is more frequently the case that the efforts of the 
bowels are not successful in carrying off their contents, and the 
stomach is perhaps at the same time so irritable, as not easily to 
retain medicine and it is difficult to rid the bowel canal of its burden. 
Under these circumstances calomel is the great remedy ; it has no 
taste, it can be retained when scarcely any other medicine will 
remain, the bulk is likewise so small and if vomiting occurs after 
it has been administered the stomach becomes less irritable, so that 
a way is open for other medicine or for nourishment ; besides calo- 
mel is seldom all thrown up. The dose of calomel, for these pur- 
poses is from one to two grains, according to age of the child, 
every two or three hours, till the bowels are disburdened of their 
load. The same are now kept in our drug stores in tubular form 
in all sizes and are readily soluble in water or milk. But it is a 



200 DISEASES OF CHILDREN. 

medicine which is slow in its operation, and it may be followed 
very advantageously with castor oil. Spiced syrup of rhubarb in 
teaspoonful doses, in combination with calcined magnesia, especi- 
ally if there is a state of acidit3 T , will also unload the intestines. 
All of these purgatives should however not be given to the extent 
of more than one or two doses and it may be aided by an injection 
into the rectum, or perhaps the injection alone will suffice. If 
there is no indigestible substance in the intestines, purgatives are 
not to be used, as they might then do more harm than good. 
Treatment, calculated to lessen the frequency of the discharges 
and to improve their character, should be commenced at the earliest 
moment. For this purpose nothing has succeeded better in my 
hands than the following agents : 

R 

Dover's Powder, 15 grains. 

Mercury with Chalk, 10 grains. 

Mix. Divide into 15 powders, (for a child a 3 T ear or more 
old). Dose. One powder every three hours in a little milk. At 
the same time employ astringents and alkalies to restrain the fre- 
quent watery evacuations, like in the following prescription : 
R 

Chalk Mixture, 2 ounces. 

Tincture Krameria, 1 ounce. 

Paregoric, ^ ounce. 

Mix and give a teaspoonful eve^ 7 hour or according to the 
frequency of the stools. Every hour that cholera infantum con- 
tinues unchecked, reduces the strength of the infant and diminishes 
his chance of recovery. But I would caution against the too 
sudden checking of the disease by the use of opiates as children 
bear this medicine badly, and there is great danger in this disease 
of the sudden supervention of stupor, amounting even to coma and 
ending fatally. Our main reliance must be on opium, in some 
form, especially for the vomiting; one drop of laudanum after the 
stomach and bowels are emptied of the indigestible substances. 
Laudanum may be given to a child five or six months old repeated 
in several hours in one drop doses, and often act very 7 happily and 



DISEASES OF CHILDREN. U01 

this amount of laudanum may be given with the other remedies 
suggested. It is too often the case that diarrhoea in children is 
allowed to run on without an}' especial notice or treatment until 
very frequently the affection becomes so aggravated as to termi- 
nate in inflammation of the bowels. It is then that vomiting, and 
not infrequently, convulsions supervene. This is, indeed, deplor- 
able, because if more care were exercised these slight affections 
would not terminate so fatally. Never neglect the slightest 
diarrhoea especially during the hot summer months. Observe 
proper cleanliness as regards nursing bottles, etc. ; care in the 
preparation of the milk, as elsewhere suggested ; attention to 
proper clothing and diet. If attention is given to these details 
You will find that cholera infantum will not be so common an 
affection and seldom fatal, consequently much less serious. The 
foregoing treatment and suggestions are invaluable in all forms of 
diarrhoea, and if given in time will surely save many a dear child's 
life. 



Part V. 
The Care of Infants During Hot Weather. 

Home Treatment of the Diseases of Infants and Children. Treatment of Colic— Consti- 
pation— Convulsions or Fits in Children— Cause and Treatment. 

Bathe infants daily in tepid water and even twice a day in 
hot weather. If delicate they should be sponged instead of 
immersing them in water, but cleanliness is absolutely necessary 
for the health of infants. As to their clothing, put no bands in 
their clothes, but make all garments to hang loosely from the 
shoulders, and have all their clothing scrupulously clean, even 
the diaper should not be reused without rinsing. The child 
should in all cases sleep by itself on a cot or in a crib and retire 
at a regular hour. A child always early taught to go to sleep 
without rocking or nursing is the healthier and happier for it. 
Begin at birth and this will be easily accomplished. 

Never give cordials, soothing syrup, sleeping drops, etc., 
without the advice of a physician. A child that frets and does not 



202 DISEASES OF CHILDREN. 

sleep is either hungry or ill. If ill, it needs a physician. Never 
give candy or cake to quiet a small child, they are sure to produce 
disorders of the stomach, diarrhoea or some other trouble. 

Children should have plenty of fresh air summer as well as 
winter. Avoid the severe hot sun and the heated kitchen for infants 
in summer. Heat is the great destroyer of infants. In excessive 
hot weather feed them with chips of ice occasionally, if you 
have it. 

Keep your house clean and cool and well aired night and 
day. Your cellars cleared of all rubbish and white-washed every 
spring, your drains cleaned with strong solution of copperas or 
chloride of lime, poured down them once a week. Keep your 
gutters and yards clean and insist upon your neighbors doing the 
same. 

As to the evacuations of the child. The healthy motion 
varies from light orange yellow to greenish yellow, in number, 
two to four times daily. Smell should never be offensive. Slimy 
mucous-like jelly passages indicate worms. Pale green, offensive, 
acrid motions indicate disordered stomach. Dark green indicate 
acid secretions and a more serious trouble. 

The following prescription is of tested value for disordered 
stomach or bowel troubles of children. 

B 

Powdered Rhubarb, one half drachm. 

Bicarbonate of Soda, one drachm. 

Essence of Peppermint, five drops. 

Water, one ounce. 

Dose. A tablespoonful before meals. May be sweetened 
when used. 

Fetid dark brown stools are present in chronic diarrhoea. 
Putty-like pasty passages are due to acidity, curdling the milk, or 
to a torpid liver. For this latter we have a panacea in the following r. 
Mercury with chalk, combined with compound ipecac (or Dover's) 
powder, one grain of each three or four times a day; the same is 
also good for all forms of summer diarrhoea in children. Can 
readily be had at all drug stores. 



DISEASES OF CHILDREN. 203' 

HOME TREATMENT FOR THE DISEASES OF INFANTS 
AND CHILDREN. 

Out of the 984,000 persons that died during the year of 1890,. 
227,264 did not reach one year of age, and 400,-647 died under five 
years of age. What a fearful responsibility therefore rests upon 
the parents who permit these hundreds of thousands of children to 
die annually! This terrible mortality among children is undoubt- 
edly largely the result of ignorance as regarding to the proper care 
and treatment of sick children. For very small children it is 
always best to use homoeopathic remedies. 

Colic. — Babies often suffer severely with colic. It is not 
considered dangerous, but causes considerable suffering. Severe 
colic is usually the result of derangement of the liver in the mother, 
or improper nourishment and it occurs more frequently when the 
child is from two to five months old. Let the mother eat chiefly 
barley, wheat and bread, rolled wheat, graham bread, fresh milk,, 
eggs, and fruit. The latter may be freely eaten, avoiding that 
which is very sour. 

A rubber bag or bottle filled with hot water put into a crib 
will keep a child once quieted, asleep for hours. If a child is 
suffering from colic, it should be thoroughly warmed and kept 
warm. Avoid giving of any kind, such as cordials, Mrs. Winslow's 
Soothing Syrup, " Mother's Friend," and various other patent 
medicines. They injure the stomach and health of the child, 
instead of benefitting it. 

Remedies for Colic. — A few tablespoonfuls of hot water will 
often allay a severe attack of the colic. Catnip tea is also a good 
remedy. A drop of essence of peppermint in 6 or 7 teaspoon- 
fuls of hot water will give relief. If the stools are green and 
the child is resting, give chamomilla. If the child is suffering 
from constipation and undigested curds of milk appear in its 
faeces, and the child starts suddenly in its sleep, give nux vomica. 
An injection of a few spoonfuls of hot water into the rectum 
with a little asafoetida, is an effective remedy, and will be good for 
an adult. 

Constipation. — This is a frequent ailment of infants. The 



204 DISEASES OF CHILDREN. 

first thing necessary is for the mother to regulate her diet. If the 
child is nursed regularly and held out at the same time of each 
day, it will seldom be troubled with this complaint. Give plenty 
of water. Regularity of habit is the best remedy. If this method 
fails, use a soap suppository. Make it b} T paring a piece of white 
castile soap round. It should be made about the size of a lead 
pencil, pointed at the end Avoid giving baby drugs. Let the 
physician administer them if necessary. The writer embraces this 
opportunity to sa) T that he has a special medicine for habitual 
constipation in children in the form of pellets which is an infallible 
remedy and posses great merits, in as much, as they are of very 
small size, almost as soluble as snow in a little water, without the 
slightest taste, or if any, the taste of candy ; they are taken with 
great relish by all children and are perfectly harmless. One pellet 
is to be given in the evening when deemed necessary by the 
mother. A box containing four dozens will be mailed to any 
address on receipt of twenty-five cents in postage stamps. 

CONVULSIONS IN CHILDREN. 

Convulsions or "fits", are of very frequent occurrence, and 
w T hile the) 7 are merely a symptom or indication of some affection 
or disturbance of some kind or other in the system, and not strictly 
a disease hy themselves. It is, however, of the highest importance 
that parents should understand more concerning the same and 
know better how to prevent and treat them when they occur. 
Convulsions occurring in a child, when not preceded by protracted 
heat and some disorder in general, are, for the most part, not 
serious or dangerous, and usually last only a few minutes, but a 
succession of them is alarming and when they supervene during 
the course of some severe disease like scarlet fever, whooping 
cough, pneumonia, cholera infantum, etc., they generally foreshow 
.great danger and the little patient frequently has to succumb to 
these combinations. 

Cause. — Convulsions in children may result from indigestion, 
worms, difficult teething, fright or anger, predisposition, (like in 
families in which there is a tendenc5 r to convulsions) premature 



DISEASES OF CHILDREN. 205 

weaning, too coarse food, and a weakened condition of the general 
health, together with anti-hygienic influences. 



TREATMENT. 

Remove the clothing with as little disturbance as possible, and 
put the child in a warm bath at once; always keep the head cool. 
An enema, (injection ) per rectum of warm water or soapsuds, 
together with a dose of castor oil are always safe when a child is 
seized with convulsions. In fact purgatives are the sheet-anchor 
and the remedy in these complaints, and it is here, where calomel 
in one or two grain doses, according to the age of the child, every 
two or three hours, until free purging takes place, works so very 
happily and saves life. Bromide of potassium in several grain 
doses, every hour, or tincture of hyoscyamus in 5 to 10 drop doses, 
according to the age of the child, are excellent anti-spasmodic 
remedies, and are great beneficial agents. It need hardly be 
remarked, that where swollen and painful gums, during teething, 
cause convulsion, they should be slightly lanced. When great 
heat exists sweet spirits of nitre, or a drop of aconite in water 
every hour or so is likewise indicated. 

Part VI. 

LARYNGITIS OR CROUP OF CHILDREN. 

This is a common or frequent disease and is of three varieties,, 
namely: 1. Spasmodic laryngitis or "false" croup; 2. Pseudo- 
membranous laryngitis or "true" croup; and 3. Diphtheritic 
laryngitis or "diphtheritic" croup. The first form occurs at all 
ages but it is so common in infancy and childhood that it is only 
described in treatises on the disease of this age. Like the other 
inflammatory affections of the air passages, it is most common in 
the cold months or when the weather is very changeable. Its- 
usual cause is therefore, exposure to cold. The protracted and 
violent crying of the young infant is occasionally a cause. In 
most cases due to the impression of cold, a running of the nose 
precedes and accompanies the attack, also chilliness, with some- 



206 DISEASES OF CHILDREN. 

times sneezing. The voice is sometimes completely lost ; a dry, 
hoarse or husky cough is also present. Attacks usually come on 
toward, or during the night, and the parents become awakened 
and terrified. The symptoms vary greatly in intensity and in 
different patients. I think this form of croup never destroys 
life, unless complicated with some severe disease, and unless utterly 
neglected. All that is necessary when these attacks come on, is 
to administer a teaspoonful of the syrup of ipecac every twenty 
minutes, or in its absence Coxe's hive syrup in somewhat smaller 
doses in the same way, and free vomiting will readily cure the 
trouble. But the second form of croup, is one of the most serious 
and fatal diseases of childhood. Pseudo-membranous or "true" 
croup, though not true diphtheritic croup, is like it, due to an 
exudation of fibrinous or false membrane upon the mucous 
membrane of the lar}mx. The exudation, like the false membrane 
in diphtheria is also caused by a bacillus, but it is not the same 
which generates the true diphtheria, nor is it so contagious. It 
occurs frequently between the ages of two and seven years, is very 
rare in adult life, and also under the age of six months. 

Causes. — There is greater liability to this disease in some 
children than in others and there seems to be an occasional heredi- 
tary predisposition in some children, for there are not a few 
parents who lose man}' children from this source, as they arrive at 
about the ages most favorable to its devolepment. Exposure to 
cold, and change of temperature are causative in this, as in the 
spasmodic form. Those children, especially, are liable to croup 
who live in heated apartments, and are taken into the open air 
without proper covering, and those who a part of the time are 
w T armly and a part of the time thinly clad, especially as regards the 
covering of the neck. It is apt to occur in children who are 
obliged to sleep in close rooms overheated during the day and cool 
at night. 

It is a question whether it ever occurs as an epidemic. Croup 
prevailing in that form (epidemically) is undoubtedly true diph- 
theria, but as the exudations and symptoms in the two affections 
similate each other so closely, it is very easy to confound the two 
diseases. Nor does it matter much, as the treatment does not differ 
very materially . 



DISEASES OF CHILDREN. 207 

TREATMENT. 

Xo delay should be made in the treatment of this form of 
the disease, as all that is to be done must be bone quickly. 
Emetics may be given the first day, as advised in the spasmodic form 
of the disease ; but if the same do not at once relieve the trouble 
a skilled physician should be hastily summoned, who will not use 
any depressing agents to procure vomiting after the first day or 
two as they can only do harm by lowering and depressing the 
vital powers. 

The following is a valuable formula for a child from three to 
five years of age : 
R 

Chlorate of Potash, one drachm. 

Muriate of Ammonia, two scruples. 

Simple S}"rup, one ounce. 

Water, two ounces. 

Mix. One teaspoonful every half hour, or in cases not 
severe, every two hours, night and day, until the cough becomes 
loose, or until it is evident that it can be of no service. A very 
important part of the treatment in pseudo-membraneous laryngitis is 
the inhalation of steam. Some of our most experienced physicians 
believe this to be more useful than all other measures combined. 
In one of the most severe cases which I have met, which termi- 
nated favorably, the room was so filled with steam that water hung 
in drops from the ceiling. The atmosphere which the child breathes 
should be constantly loaded, with moisture without, however, that 
degree of heat which would add materially to the discomfort of the 
patient or attendants. The moist air coming in contact with the 
inflamed surface promotes expectoration and renders the cough 
looser. Steam may be readily produced by placing heated irons 
or bricks in a shallow pan or pail containing a little water, or by 
pouring water upon a heated surface. In order to avoid heating 
the entire room and to concentrate the vapor, the nurse may sit 
with the child under a frame covered with a blanket, and the 
steam be produced underneath. 

Tracheotomy is the next recourse, and the writer is much in 
favor of the surgical expedient, when the medical measures seem 



208 DISEASES OF CHILDREN. 

to fail, and would suggest that the operation be not too long delayed 
until the ease becomes, altogether too hopeless. It need hardly be 
remarked that in true diphtheritic cases where the larynx once 
becomes fully involved and ' ' true croup ' ' takes place that no 
operation should be perforned in such cases. Moist air, as per the 
steam atomizer is the chief, as well as the very best resort, as a 
local rernedj^. 

The third or last form of this disease — true diphtheritic croup 
is so extremely grave and recovery is so exceeding!} 7 rare that 
very little hope can be extended. The application of nitrate of 
silver solution and tincture chloride of iron wtth glycerine, steam 
with carbolic sprays; and the usual remedies — iron, quinine, 
whiskey, etc., generally prescribed in diphtheria are our only 
sources of avail. 

Part VII. 

WHOOPING COUGH. 

Pertussus, (from the Latin per, intensive, and tussus, cough) 
or whooping cough, has derived its name from the fact that the 
cough is distinguished b}' a prolonged, forcible characteristic 
crowing or whooping noise, though man}- cases of whooping cough, 
exist without this characteristic sound, which makes the diagnosis 
extremely difficult, especially at the beginning. It is especially a 
disease in early life. No period of life is, however, exempt from 
the susceptibility to the contagion and the infrequency of the 
affection after childhood is accounted for 03- the fact that the great 
majority of persons experience it before they are grown up. It is 
a highly infectious or contagious disease, often epidemic, rarely 
occurring more than once in the same individual, and when severe 
and complicated with convulsions, pneumoyiia (breast fever) 
capillary bronchitis and a host of other affections, which are liable 
or apt to supervene, very dangerous. When simple and uncompli- 
cated the prognosis is ordinarily favorable, nearly all recovering 
under such circumstances. 

In rare instances death may occur in or immediately after a 
paroxysm of coughing, in consequence of rupture of small blood- 



DISEASES OF CHILDREN. 209' 

vessels in the brain or by the occurrence of apoplexy. The dis- 
ease may likewise prove fatal through inanition or starvation, the 
paroxysms of coughing and vomiting being so frequent as to im- 
pair the nutrition of the little sufferer and carry it off in that way. 
Whooping cough prevailing in the summer season and associated 
with cholera infantum or dysentery, becomes one of the gravest 
affections and is frequently fatal, but death occurring in such 
cases is due to the complications rather than the pertussus. The 
disease usuallj' commences with the symptoms of on ordinary 
cold or common catarrh ; slight chills followed by heat, swelling 
of the countenance (face) , running of the nose, restlessness with 
irritability and troublesome cough. In the course of a few days 
the slight disturbance of the health ceases, but the cough con- 
tinues, changes its character, and becomes convulsive and pro- 
longed, and is attended with expectoration of ropy mucus in great 
quantity. As the severity of the cough increases, the paroxysms 
assume the suffocative character, which terrify the patients ; the 
vessels of the head, neck and face become swollen during each 
attack ; the eyes appear as if starting from their sockets and the 
nose may bleed, the danger and gravity of the disease depending 
on the number, frequency and intensity of the paroxysms of 
coughing. Its duration varies from two to three weeks to many 
months. The cough is always most severe at night, and the first 
sign of improvement is manifested by a decrease in these noc- 
turnally exacerbations. Then the paroxysms become altogether 
less severe and less frequent, until at the end of perhaps three 
weeks or even earlier no symptoms remain. Under the influence 
of exposure to cold or of improper food, however, the cough may 
return with all its symptoms, so that for some weeks after apparent 
recovery great care will be needed. The appetite in simple uncom- 
plicated cases is seldom impaired, even if the cough end in an 
attack of vomiting, as it so frequently does, the patient has a crav- 
ing for food directly afterwards and asks for something to eat. 

TREATMENT. 

To describe all the remedies which have been proposed for the 
cure of this affection would occupy much space ; in fact, there are 

15 



210 DISEASES OF CHILDREN. 

few remedies in the whole Materia Medica which have not at one 
time or other been much lauded for it, but as the majority of them 
are worthless, such a labor is unnecessar}^ The object of treat- 
ment must be to keep the disease simple, to prevent other affections 
from complicating it, for since it arises from a specific contagion, like 
small-pox or scarlet fever, so it has a tendency to run a certain course 
uncontrolled by art, but much good can often be done by skillful 
physicians. Where convulsions threaten or exist bromide of potassa 
in moderately large doses is highly indicated and is the sheet anchor, 
in fact, in such cases. It has likewise a very salutary effect upon 
the cough in all cases. The remedies like antipyrine, belladonna, 
hydrocyanic acid, and their like ; all are very valuable, but 
must only be administered under the advice of a good physician. 
When debility and bloodlessness result or remain after whooping 
cough the bitter tonics and iron should be prescribed, as pulmon- 
ary consumption sometimes follows this complaint under such 
circumstances. 

Part VIII. 

CHOREA OR "ST. VITUS 'S DANCE." 

The affection called chorea, chorea sancti Viti, or St. Vitus' s 
dance, is characterized by irregular clonic contractions of more or 
less of the voluntary muscles, giving rise to movements which are 
either involuntary or not under the guidance of the will. The 
manifestations of the affection are usually at first limited to a 
portion of the body, to one of the upper extremities oftener than 
elsewhere, and sometimes they are confined, for a time, to the 
fingers of one hand. The movements increase and progressively 
extend to both upper extremities, the muscles of the face, and 
frequently to the lower extremities and to the trunk. The appear- 
ances consist of frequently recurring or unceasing movements of 
the parts affected, producing in the face varied and ludicrous 
grimaces, and in the extremities and trunk grotesque contortions 
and fantastic gesticulations. The spectacle afforded by the mani- 
festations of this affection is comical, and it is difficult to realize 



DISEASES OF CHILDREN. 211 

that it is not a performance for the amusement of observers. The 
condition has been well designated an "insanity of movement." 
The condition, however, if the affection be severe, is truly distress- 
ing. The incessant activity of the muscles induces fatigue. The 
patient may be unable to perform the voluntary acts which the 
wants of the body require and is completely dependent upon 
others. Speech may be impaired or lost. Locomotion may be 
impossible. The isolation is sometimes more complete than in 
cases in which a considerable portion of the body is paralyzed or 
several senses abolished. The movements in chorea are usually 
suspended during sleep, but they sometimes continue, although 
always more or less diminished. They are increased generally 
when the patient is conscious of being observed, and under any 
emotional excitement. The movements are frequently more 
marked on one side of the body, and this is generally the left side. 
They are sometimes confined to this side, and the affection is 
then called hemi-chorea. The affection is not accompanied by 
fever. If this exist, it is due to an intercurrent or co-existing 
affection. The appetite is usually more or less impaired and the 
bowels are constipated. Anaemia often co-exists. Irritability of 
temper is a notable feature and the mental faculties are weakened. 
Tenderness along the spinal column exists in a large proportion of 
cases. 

The causation of chorea is obscure. It is common to suspect 
the presence of worms in the alimentary canal, but there is little 
evidence that the affection is caused by worms. It is sometimes 
traced distinctly to fright, or to violent mental excitement, as a fit 
of anger. Its development is favored by anaemia, in most cases 
patients are anaemic. There is reason for suspecting sexual ex- 
citement as a cause in some instances. It may be produced by 
unconscious imitation. This has been .shown frequently by 
its prevalence in schools. It occurs occasionally in pregnancy. 
Chorea occurs especially between 10 and 15 years of age. It 
rarely occurs under 6 years of age. It may occur at any period of 
life. Henri Roger has reported a case occurring in a female aged 
84 years. Graves observed a well marked case in a male aged 72 
years. On the other hand, cases have been observed in infants 



i 



212 DISEASES OE CHILDREN. 

shortly after birth. Girls are more liable to it than boys, the ratio 
being as three to one. The duration varies from a few weeks to 
several months. The average duration is from two to three 
months. In the vast majority of cases the termination is in recover}'. 
After a variable duration, the affection tends intrinsically to this 
termination. In a very small majority of cases it becomes chronic, 
and is incurable. Life ma}' be destroyed by intercurrent affections 
which, in general, do not suspend the choreic phenomena. A 
fatal result may take place without any superadded disease, the 
patient being worn out by prolonged irritation, loss of sleep, and 
inanition. The incessant movements sometimes give rise to con- 
tusions and excoriations which may lead to erysipelas and abscesses, 
and these may contribute to a fatal result. Occurring in pregnancy 
it is apt to lead to abortion or premature deliver}- and hence, is not 
without danger. Relapses are apt to occur after intervals varying 
from a few months to two or three years. As a rule, the relapsings 
are shorter than the primary attacks. 

A diversity of remedies have been advocated as effecting a 
cure of this disease. In general, when different methods of 
treatment of any disease are found to be successful, it is a fair 
inference that the disease ends favorable from an intrinsic tendency. 
This is undoubtedly true of chorea. Of the diverse remedies 
indicated, none can be relied upon for promptly arresting the 
course of the disease, and it is doubtful if any exert a special 
curative agency. It by no means follows, however, that much 
benefit may not be derived from judicious treatment. The greater 
part of the remedies are doubtless more or less useful, and the 
physician is to exercise judgement in adapting them, severally, 
to individual cases, and in employing them successively in the same 
case. Rational indications, in the first place, are to be sought for 
in co-existing disorders or morbid conditions. If there be 
symptoms, apart from the chorea, pointing to rheumatism, 
remedies addressed to this condition are called for. Anaemia, in 
a large proportion of cases, calls for appropriate treatment. 
Constipation, if present, claims attention. Purgative remedies are 
among those advocated as efficacious in curing the disease. Causes 
of peripheral irritation, especially those of sexual origin, should 



DISEASES OF CHILDREN. 213 

be removed. Of remedies, other than purgatives, which experience 
has shown to be useful, the more important are, arsenic, the 
carbonate and prussiate of iron, zinc, strychnia, opium, cannabis 
indica, and various antispasmodics. Of the efficacy of arsenic 
there is abundant and strong testimony. Fowler's solution is the 
most eligible preparation. Commencing with three or four drops 
three times daily, the doses should be gradually increased until 
the characteristic effects are observed. Of the preparations of 
iron, the carbonate and prussiate have been supposed to exert a 
curative effect, aside from their usefulness with reference to co- 
existing anaemia. The writer has been highly successful with the 
following prescription in these cases : 

R 

Ammoniated Citrate of Iron (soluble), 2 drachms. 
Fowler's Solution of Arsenic, 2 drachms. 

Water, 6 ounces. 

Dose. A tablespoonful after meals, three times a day, for 
children. 

Of the preparations of zinc, the oxide has been especially 
advocated as curative in this affection. Strychnia was advocated 
by Trousseau, who preferred the sulphate dissolved in syrup. 

Hygienic measures are certainly not less important than 
remedies. Alimentation as nutritious as possible is desirable. 
Daily exposure, and, if practicable, exercises in the open air, are 
highly important. 

The cold sponge bath is useful, provided it be not dreaded by 
the patient, and it is to be followed by brisk reaction; the shower 
bath, with the same provisions, is admissible. On the other 
hand, the tepid bath, as a palliative measure, is highly useful. In 
the Children's Hospital in Paris for many years much reliance has 
been placed on gymnastic exercises for the cure of chorea. After 
the choreic movements have ceased, more or less inability to co- 
ordinate movements, together with muscular weakness, remains, 
and these effects of the disease are to be removed by exercise. 
The power of again directing the muscles is to be acquired as in 
infancy, but it is acquired rapidly. 



CHAPTER XX. 
Special Medical Diseases. 

Pharyngitis, Tonsillitis or Quinsy— Clergyman's Sore Throat or Catarrh of the Throat — 
Catarrh of the Nose— Asthma, Its Causes and Treatment. Appendicitis. Bronchitis — 
Pneumonia— Pleurisy or Pleuritis — and Their Treatment. Pulmonary Consumption,. 
Its Origin, Cause, Prevention and Treatment. 

PHARYNGITIS, TONSILLITIS OR QUINSY — CLERGYMAN'S SORE 

THROAT OR CATARRH OF THE THROAT AND THEIR 

TREATMENT. 

The pharynx is the muscular funnel shaped bag situated at 
the back part of the mouth, which receives the masticated food and 
conveys it to the oesophagus, in which it terminates. Pharyngitis 
is inflammation of the mucous membrane of the pharynx : The 
tonsils are round or oval shaped glands situated between the arches 
of the palate. They are supposed to emit a kind of secretion which 
arrests and destroys bacteria. Tonsillitis means inflammation of 
the tonsils. 

Acute inflammation of the pharynx may be limited to the 
mucous membrane or associated with inflammation of the tonsils. 
Associated with inflammation of the tonsils it constitutes the affec- 
tion called tonsillitis, commonly known as quinsy. The tonsil on 
one side only or both tonsils may be affected. In their natural 
state the tonsils can easily be discerned slightly projecting on each 
side of the fauces, but when inflamed they are frequently very 
much enlarged, being bright red, and often hanging down, so as 
nearly to close the passage of the gullet, and render swallowing 
very difficult. With enlarged tonsils there is alwa} T s more or less 
thickness of speech. Acute tonsillitis frequently ends in suppura- 



SPECIAL MEDICAL DISEASES. 215 

tion ; an abscess forms, and purulent matter, sometimes fetid, and 
nauseous to the taste, is discharged after a period varying in differ- 
ent cases from two to ten days. When the abscesses point, they 
ma}' be opened and the patient is thus relieved sooner than if they 
were left to break. It is a very distressing affection in consequence 
of the pain and difficulty of deglutition (swallowing), but is very 
seldom attended with danger. An attack of tonsillitis is sometimes 
attributable to exposure to cold, but it often occurs without any 
obvious causation. The causation involves a predisposition to the 
affection, and persons predisposed are apt to experience repeated 
attacks. The treatment consists of poultices to the neck, or the 
water dressing and the inhalation of warm vapor. Quinine in large 
doses often aborts an attack, so also does guaiacum when given at 
the outset. Gargles of white oak bark or sumach, alum and Mon- 
sell's solutiou of iron are greath T beneficial. Nitrate of silver 
applied to the affected part may likewise arrest the inflammation. 
Tincture of iodine, injected is used to gradually diminish a hyper- 
trophied (enlarged) tonsil. In hypertrophy of the tonsils it is 
usually the best plan to have the tonsils cut out by a surgeon ; this 
is not a dangerous nor very. painful operation. 

Simple acute pharyngitis, that is, the inflammation limited to 
the mucous membrane, is an affection of frequent occurrence. It 
is one of the forms of " a cold." The inflammation may extend 
over more or less of the pharyngeal space and fauces, and upward 
into the posterior nares. It occasions more or less pain in the act 
of swallowing and the patient is annoyed by a constant disposition 
to swallow. After a time a secretion of mucous takes place, and 
this provokes efforts at hawking and expectoration. The cough 
is of a peculiar character, being easily recognized as a throat cough. 
The tonsils sometimes present a deposit of a white material in 
patches of greater or less size. The condition is inflammatory 
and is called follicular tonsillitis. These white patches have a 
resemblance to those seen in diphtheria, and it is very often the 
case, on this account, that this affection is mistaken for it. The 
follicular deposit occurs without any abrasion of the mucous surface, 
but it is common for people to consider the patches ulcers. 

Chronic pharyngitis, in this country, is an extremely common 



216 SPECIAL MEDICAL DISEASES. 

affection. It is commonly known as " the catarrh " or catarrh of 
the throat. In some persons it occasions but little inconven- 
ience. It is often found when the person makes no complaint 
of any trouble in the throat. In other cases, it occasions 
more or less annoyance. An incomfortable sensation is felt 
in the throat. The presence of adhesive mucus excites 
efforts of hawking and coughing. The proximity of the inflam- 
mation to the larynx may give rise to a dry, hacking cough. The 
voice becomes slightly hoarse after considerable use in speaking or 
reading. The use of the voice is followed b}- a sense of fatigue in 
the vocal organs. The affection is more frequent in men than in 
women, and it occurs most frequent^ after the age of fifteen and 
in middle life. From its frequent occurrence among the clerg3^, it 
has been called clergy mem' s sore throat-, but it is \yy no means 
peculiar to the clerg}^, occurring oftener in persons of other callings. 
It occasions more inconvenience to clergymen than to others, from 
the necessity which they are under of using the voice in public 
speaking, and they are apt to be apprehensive lest it may incapaci- 
tate them from preaching. It may be doubted whether the use of 
the voice leads to the affection. It occurs especially among persons 
of sedentary habits who suffer from the wear and tear of continued 
application, without physical and mental relaxation. The number 
of persons is very large in this country who over-task the powers 
of the system by stead} T labor in the office, the counting-house, or 
the workshop, continued without intermission for many years, 
giving no time whatever for recreation. It is among those who in 
this way violate the laws of health that this affection prevails. It 
seldom occurs among the so-called laboring classes, and it is much 
more frequent in cities than in the country. It is accompanied 
with symptoms denoting impairment of the general health. 
Patients complain of debilit3 T and a want of their customary energy ; 
they are apt to fane}- the existence of some serious disease especi- 
ally pulmonary consumption, and it is sometimes difficult to 
convince them that the latter disease does not exist. Patients with 
this affection rarely become tuberculous ; its existence is to some 
extent, evidence of the non-existence of phthisis. The treatment, 
to be effective, must have reference to the system. Topical appli- 



SPECIAL MEDICAL DISEASES. ^17 

■cations alone are rarely efficacious. A fair trial of them , however, 
should be made. The nitrate of silver in strong solution (20 or 
30 grains to the ounce) in some cases, especially of the granular 
variety, is highly useful. A solution of tanin is often of service. 
The chloride, iodide, or sulphite of zinc, and iodoform are recom- 
mended. Projecting a spray of medicated solutions into the throat 
is an efficient mode. Inhalations carry the medicated application 
too far and on this account they are not appropriate. On the 
other hand, gargles are of little use ; they do not carry the appli- 
cation far enough. The constitutional remedies which exert a 
curative influence in certain cases are the iodide of potassium, the 
bromides, the chlorate of potassa, and the lrydrochlorate of 
ammonia. Alteration of the habits of life is first in importance. 
Relaxation, recreation, and out of door life are for more efficacious 
than medicines, and the latter are of little use without the former. 
AVhen circumstances permit relinquishment of business, for a time, 
for travel or rural occupations, is of signal benefit. Tonic remedies 
may often be of advantage, but tonics to be efficacious, should be 
continued for a long period, and the form of tonic changed from 
time to time. The diet should be nutritious. The object of 
treatment, in short, is to restore the general health. The annoy- 
ance from chronic pharyngitis is often much enhanced by patients 
concentrating their attention upon it. They sometimes fall into a 
habit of constant hemming or " clearing the throat," which is not 
onl3 T fatiguing to themselves, but extremely disagreeable to others. 
The importance of making an effort to avoid such a habit, and to 
think of the affection as little as possible, is to be inculcated. 



CATARRH OF THE NOSE AND ITS TREATMENT. 

Nasal catarrh is an inflammation of the mucous membrane 
lining the nose, which may be acute, subacute, or chronic in 
-character, and is a very common affection, especially the acute 
variety. Children are especialty prone to it, the attacks promptly 
following any improper exposure to cold or wet. It is thus likely 
to prevail extensively in cold, damp, and changeable weather. 



218 SPECIAL MEDICAL DISEASES. 

Acute nasal catarrh is certainly transmissible by means of the 
handkerchief. Foreign bodies — buttons, grains of corn, pebbles, 
peas, cherry-pits, etc., may likewise cause the disease, and should 
not be overlooked. 

Repeated attacks of the acute affection tend to produce, the 
chronic form of the disease, especially in such persons who are 
predisposed to catarrhal inflammations. It is sometimes due to 
S3'philis. 

TREATMENT. 

In the milder cases of acute nasal catarrh but little treatment 
is required. A hot foot-bath at night, with a dose of Dover's 
powder, of 5 to 10 grains for an adult, followed in the morning by 
a single dose of quinine (10 grs. ) very often aborts or lightens an 
attack. When the constitutional disturbance is marked, and 
especially when fever is present, the person should keep his room. 
Under such circumstances repeated, small doses of Dover's powder, 
2 to 3 grains even- two hours will prove of service. Tonic doses 
of the salts of quinine will likewise do good. In the early stage 
nothing is so grateful or so efficacious in relieving s3 7 mptoms 
caused by the swelling of the mucous membrane as the applica- 
tion of a 2 to 4 per cent, solution of cocaine, applied as a spray or 
with camels hair pencil. Vasaline to which acetate of morphine 
may be added, is also a good local application, well introduced 
into the nasal passages. 

Cleanliness is of the utmost importance in the treatment of all 
forms of nasal catarrh. Prof. Seiler, of Philadelphia, has devised 
a soothing and cleansing solution which gives great relief used as 
a spray or snuffed into the nostrils, several times per day. The 
same is kept in tablets, in all good drug stores. Ask for Carl 
Seller's Antiseptic Tablets. Dissolve one tablet in two fluid 
ounces of water (four tablespoon fuls) and use as spray, douche, 
etc., and you will obtain more benefit than, by all the quack 
preparations advertised in our daily newspapers. Nasal injections 
or lotions should always be warmed before used. In chronic 
catarrh the system is always debilitated more or less and no sue- 



SPECIAL MEDICAL DISEASES. 210' 

cessful issue can be obtained without the administration of iron, 
and vegetable tonics. 

CHRONIC NASAL CATARRH. 

In view of the fact that most cases of this form of the disease, 
require operative procedures, it is needless to add that its success- 
ful treatment requires first-class technical knowledge, and I would 
recommend that persons thus afflicted avail themselves early of 
the skill of the specialist. But in recommending a specialist, 
I do not mean the advertising quack, who generally has no 
knowledge at all of this troublesome affection, merely flooding 
the country with his spurious literature and worthless nostrums 
for mercnary ends, but the learned and reputable surgeon who 
may practice this class of diseases as a specialty. 

ASTHMA, ITS CAUSE AND TREATMENT. 

Asthma is a disease characterized by periodical paroxysmal 
attacks of difficult or painful breathing. These paroxysmal 
attacks may last from a few minutes to several days. The attacks 
generally come on during the night and are due to a contraction 
of the bronchial tubes. 

Of all the numerous causes of asthma, bronchitis is the most 
frequent, and it goes without saying, if the attacks of bronchitis 
can be prevented, or cured, there is no more asthma. The disease 
is sometimes hereditary (transmitted from the father or mother). 
Mental emotions, indigestion and hysteria may also be mentioned 
as occasional causes. There are persons who only have asthma at 
certain times of the year and in certain localities, the attacks 
being caused by the inhalation of pollen, or odor of plants. This 
constitutes ' ' hay fever " or " autumnal catarrh ' ' . 

The first object of treatment is to cut short the attacks, for 
which employ such means as will relax the spasmodic contraction 
of the walls of the bronchial tubes. This can be done in a variety 
of ways — inhalation of the fumes of stramonium (as suggested in 
describing this plant), saltpetre, chloroform, sulphuric ether, or 
nitrite of amyl ; a hypodermic injection of one-fourth grain 



220 SPECIAL MEDICAL DISEASES. 

morphine with one one-hundredth grain atropia, (for an adult), 
or a ten grain dose of chloral hydrate, given by mouth, will almost 
instantaneously relieve a spell of asthma. The use of drugs which 
promote the expectoration, among these lobelia (Indian tobacco), 
also assists in mitigating an attack. 

To prevent the recurrence of the attacks, we examine into 
the cause of the asthma, and if chronic bronchitis is at the bottom 
of the affection, the following formula is of tested value by the 
author: Iodide of potash, muriate ammonia, of each three drachms; 
syrup tolu, glycerine, paregoric, of each two ounces. Mix, and 
take a teaspoonful four times a da}', an hour after each meal, and 
on going to bed. An}* druggist can put up this mixture. 

If the trouble persists, I would recommend change of climate 
and mode of living. In the selection of climate for the asthmatic, 
there is, however, no rule to guide us. Each person must travel 
from place to place until he finds the particular spot where he 
ceases to have asthma. 



APPENDICITIS — CAUSE AND TREATMENT. 

Appendicitis — is an inflammation of the Appendix Yermifor- 
mis, a long, narrow, worm-shaped tube, the rudiment of the 
lengthened caecum found in all the mammalia ; it varies in length 
from three to six inches, its average diameter being about equal to 
a goose-quill and terminates in a blunt point. It is retained in its 
position by a fold of peritonium. Foreign bodies, like seeds from 
grapes, cherry pits, etc., feces and other sources of irritation easily 
set up inflammation. Appendicitis is a frequent affection in our 
time and its assumed rarity in former years is explained by the fact 
that the disease was not so well understood, as at present. The 
symptoms, are about as follows : rise of temperature or fever, 
nausea (perhaps vomiting), abdominal pain, sometimes intense, 
often diagnosed as mere colic, and tenderness of the more or less 
rigid muscles. The point of greatest tenderness is found over a 
spot about two inches from the upper and highest point of the left 
hip-bone, on a line extending from this point to the navel. Upon 



SPECIAL MEDICAL DISEASES. -5^1 

deep pressure or feeling, a tumor ma}' often be felt, marking the 
seat of the impaction, swelling and inflammation. 

TREATMENT. 

Suppuration ordinarily takes place ; although under judicious 
management — morphine hypodermatieally (injected as near the seat 
of the pain as possible) with hot applications etc. , we may succeed 
in soothing down the attack, and the impaction may work its way 
back into the intestines, especially if the same is merely feces, and 
recovery may take place without an operation, but with perforation, 
death is sure to come. Surgical or operative interference is always 
indicated and should not be too long deferred. Ordinarily an 
incision four and a half inches long should be made in the seat of 
the swelling — all pus carefully removed, the appendix ligated (tied) 
and cut off ; the parts thoroughly w r ashed out with disinfectants, 
and packed with antiseptic gauze and recover is rapid and undis- 
turbed. With our present knowledge of antiseptics this operation 
is not at all dangerous — if resorted to in time. But it goes without 
sa3'ing that only a very skilled surgeon should be called to operate. 

BRONCHITIS AND ITS TREATMENT. 

-Bronchitis is an inflammation of the lining membrane of the 
bronchial tubes. This, in its ordinary form, is the most frequent 
of the pulmonary inflammations, and is a very common affection in 
all parts of the globe. The inflammation is limited, generally, to 
the large bronchial tubes and if not associated with other affections, 
a dangerous disease only when it occurs in the young, aged, and. 
feeble. The danger in these classes of patients, arises from the 
accumulation of the products of inflammation — mucus, etc. , within, 
the bronchial tubes, and the danger is from suffocation chiefly. 
Capillary bronchitis is an inflammation of the small tubes, and is- 
a very grave form of the disease, especially in children, but it is 
happily quite rare in grown people. The affection may be acute,, 
subacute, or chronic in form, and the degree or severity and 
duration of the inflammation depend on these varieties. Bronchitis 
in its epidemic form constitutes influenza or la grippe. 



; 



222 SPECIAL MEDICAL DISEASES. 

SYMPTOMS. 

Acute bronchitis is most generally preceded by coryza (a 
cold in the head) or an acute catarrhal inflammation of the mucous 
membrane lining the nose, traveling downward, either affecting, 
or passing by, the pharynx and larynx in its passage to the 
bronchial tubes. The time occupied in its passage may vary from 
a few hours to one, two, or three days. In some cases, the bron- 
chial tubes are attacked at once, without any affection of the air- 
passage above, and again the subsequent inflammation in the 
bronchi, may not have extended from the nose, etc., but by a 
separate invasion from a common, internal determining cause. 
Pain in the chest is seldom a prominent symptom, differing 
in this respect very greatly from acute pleurisy and pneumonia, 
which are very painful. But there is a sense of tightness and of 
soreness or rawness. These painful sensations especially accom- 
pany acts of coughing. The appetite may be more or less impaired , 
but is not usually lost. The pulse and temperature are not notably 
affected. The average duration of acute bronchitis is ten to twelve 
days. The affection is seldom accompanied by much debility — 
patients are generally not confined to the bed, and they may not 
confine themselves to the house even. Cough is often the most 
prominent s} 7 mptom. It is at first dry, the secretion of mucus 
being for a time scanty. Deep inspirations, breathing cold air, 
and the exercise of the voice excite acts of coughing. The expec- 
torated matter is often streaked with blood, and is at first small, 
frothy and sticky, but in the progress of the disease, after two, 
three or four days, the expectoration becomes more abundant, and 
consists of thick, yellowish, or greenish matter. The cough is 
then said to be loose, the expectoration is much easier, the pain 
and soreness cease, and the person becomes much more comfortable. 

Causation. — Bronchitis is most generally produced b}^ the 
action of cold, and the affection is popularly known as " a cold." 
Exposure to cold is supposed to produce the disease by inter- 
rupting or checking the perspiration or the eliminative functions 
of the skin, whereby an increased duty is thrown upon the mucous 
membrane of the lungs and by inducing internal congestion. The 



SPECIAL MEDICAL DISEASES. 223 

disease may also be produced by irritating gases received with the 
inspired breath or develop the course of other diseases, as a second- 
ary affection. 

TREATMENT. 

Acute bronchitis can be prevented in man)' instances, on the 
appearance of coryza, or the snuffles, by a full opiate and diapho- 
retic (an agent producing sweating). A ten grain dose of Dover's 
powder (which can be obtained at an} 7 drug store), serves this 
purpose well — which should be taken for this object at bed time, 
accompanied by a hot foot-bath and some warm stimulating drink 
— like weak punch or toddy, or plenty of warm tea, followed in 
the morning by a good purgative. If this plan of treatment does 
not succeed in stopping bronchitis, or a cold, it may mitigate the 
severity of the affection. A full dose of quinine (5 to 10 grains to 
an adult) will often act as a preventive, or, given at once when the 
bronchial tubes become affected, as an abortive remedy. The 
same dose of salicin, repeated once or twice after an interval of two 
hours, will be equally effective to prevent or arrest the complaint. 
If the disease become established no very active treatment is neces- 
sary, in view of the almost uniform tendency to recovery with mere 
attention to hygiene. 

The following is a very valuable cough mixture : 

R S3 T rup of Ipecacuanha, one ounce. 

Paregoric, one ounce. 

Simple Syrup, one ounce. 

Mix. Take two tablespoonfuls every hour. The dose for a 
child one to five years is half to a teaspoonful. Coxe's Hive 
Syrup, may be substituted for the ipecac. During the acute 
stage, if pain and soreness of the chest be prominent symptoms, 
mustard plasters or stimulating liniments are useful. If the affec- 
tion linger and threaten to become chronic, quinine or chinconida 
and other tonics, together with a nutritious diet become necessary. 
In protracted bronchitis or in the chronic form of the disease. I 
have been led by experience to regard the following prescription 
.as invaluable, viz. : 



1 



224 SPECIAL MEDIC AE DISEASES. 

R 

Iodide of Potassium, three drachms. 

Compound Syrup of Squills, one ounce. 
Glycerine, one ounce. 

Paregoric, one ounce. 

Simple Syrup, one ounce. 

Mix. Take a teaspoonful, four times a day, after each meal, 
and before going to bed. Children according to age. 

ACUTE BRONCHITIS IN YOUNG CHILDREN. 

Acute bronchitis in young children, is surely the most: 
frequent disease of early life. It is usually associated, like in the 
adult with more or less inflammations in the nose and windpipe. 
It occurs both as a primary and secondary disease. The second- 
ary form is very common in connection with measles, whooping 
cough, pneumonia, and consumption, and is not rare in scarlet 
and other fevers. Its severity or mildness as in grown people, 
depends, on the grade of the inflammation ; that is, on the acute, 
subacute, or chronic form. Bronchitis usually affects the tubes 
on both sides with about equal intensity. 

Causes. — The cause of primary bronchitis is the same as that 
in other simple acute inflammation of the air passages and lungs, 
namely : sudden change of temperature from warm to cold, 
exposure to currents of air, the practice of sending the children, 
without proper or sufficient clothing from heated rooms into the 
open air, the throwing off of bedclothes at night, etc. Teething 
may also be an occasional cause. 

Symptoms and Prognosis. — The symptoms of acute bronchitis 
in children vary very greatly in severity in different patients. It 
usually commences with more or less coryza. Other symptoms- 
are headache, flushed face, heat or elevation of temperature, 
acceleration and fullness of pulse. In the mildest cases these 
symptoms are scarcely appreciable. The child is noticed to sneeze, 
have some running from the nose, perhaps no appreciable heat, 
and but a mild cough, being well in the course of a few days. But 
there is a graver and severer form of the disease, also a common 



! 



SPECIAL MEDICAL DISEASES. 225 

occurrence, when the inflammation is of a severe type, exclusive 
of those cases in which the minute branches of the bronchial tree 
are affected. In severe bronchitis the pulse rises to 120 or 130 
per minute, and the breathing is in like degree accelerated. The 
cough is frequent and painful. The face is greatly flushed and 
indicative of suffering, much heat with great impairment or 
perhaps complete loss of appetite. It may commence quite 
abruptly, but ordinarily it results from the milder form of the 
disease, the inflammation having extended downward. When 
the disease thus affects the smaller tubes and air-cells it constitutes 
capillary bronchitis or suffocative catarrh and is a very dangerous 
affection. Sixty to eight}' respirations are not unusual, while the 
pulse rate may attain as high in number as 140 to 160 or 180 beats 
per minute. The little patient is very restless, moving from one 
part of the bed to another, seeking in vain for relief. 

The face now becomes ghastly pale, the lips blue, and the tips 
of the fingers blue and cold ; an unfavorable prognostic, but not 
a few recover under stimulation in whom it occurs in the hands of 
skilled physicians. 

TREATMENT. 

Bronchitis in children may be rendered much milder, and, 
perhaps even prevented, by an emetic employed in the first twelve 
or twenty-four hours, in connection with a warm bath. But as 
the physician is not, ordinarily called sufficiently early to render 
this treatment effectual, it devolves upon parents and attendants, 
to early administer, in a severe cold or cough, a mild medicine to 
procure vomiting. The following is a good mixture for the 
purpose : 

R 

Compound Syrup Squills, one ounce. 

Syrup Ipecacuanha, one ounce. 

Simple Syrup, one ounce. 

Mix. Give a teaspoonful to a child one year old every half 
hour till vomiting is produced when it may be given with very 
great benefit, in somewhat smaller doses to loosen the cough. 

16 



226 SPECIAL MEDICAL DISEASES. 

Sweet spirits of nitre is beneficial, especially in cases of heat. A 
good laxative as a full dose of castor oil should always be given 
in a case of bronchitis at its commencement. The following 
formula will also be found useful for infants affected with simple 
bronchitis : 

R 

Sweet Nitre, two drachms. 

Syr. Ipecac, two drachms. 

Castor Oil, two drachms. 

Syr. Tolu, four ounces. 

Mix. One teaspoonful every two hours. 

If there is much heat one or two drops of tincture of digatalis 
according to the age may be given with the foregoing mixtures. 

If these means do not succeed in relieving the little patient 
call a plrysician. 

The following formula is of great merit when a stimulating 
cough remedy is indicated : 

R 

Carbonate of Ammonia, twenty grs. 

Tinct. Sanquanaria, twenty-five drops. 

S} 7 r. Senega, two drachms. 

Extract Licorice, one drachm. 

Water, two ounces. 

Mix. A teaspoonful every two hours for a child two years 
old. 

The chest should be well protected with oiled bilk, woolen 
cloths or packed with cotton. Stimulating liniments, small mustard 
plasters or warm hop-bags applied to the chest, should not be 
neglected. 

PNEUMOXIA. 

Pneumonia, or pneumonitis, is an inflammation of the sub- 
stance of the lungs. In technical language the term, pneumonitis, 
designates inflammation of the panenchyma ( whole body ) of 
the lungs as distinguished from those of the bronchi and the plura. 



SPECIAL MEDICAL DISEASES. 227 

In other words by panenchyma of the lung is meant the air vesicles, 
the air passages, and the smaller bronchi. It is also known as lung 
fever and popularly as ' ' breast fever. ' ' There are few countries 
in which it does not prevail. In the United States it is said to be 
more frequent in the South than in the North and of most frequent 
occurrence from February to May. The disease occurs much 
oftener among males than females. Tuberculous patients are not 
particularly prone to this disease. It also prevails much more in 
some years than in others. In a large portion of cases, the disease 
is developed spontaneously ; that is, it is not referable to any 
obvious causative agency. It has as yet not been settled, whether 
it is contagious or not. Medical writers divide the disease into 
three stages, designated the first, second and third stages, but the 
scope of this article does not allow to describe the affection so 
minutely. The prognosis in acute pneumonia depends largely on 
the extent of lung involved, the intensity of the fever, its compli- 
cations, the previous constitution of the patients, etc. In the aged 
and feeble it is a disease of much gravity in a severe form. The 
disease is readily known to the educated physician by the physical 
signs ,as revealed by auscultation (the act of listening to the respi- 
rations) and percussion (the act of sounding the chest with short 
quick blows, as upon the fingers, etc.) The characteristic rust- 
colored expectoration, is also an infallible sign of the disease. 

TREATMENT. 

Experience has abundantly shown, that the measures formerly 
employed to arrest or abort the disease, as blood clotting, cathartics 
and other remedies entering into the so-called antiphlogistic method 
of treatment, cannot be relied upon for the arrest of this disease, 
more than of other inflammations. Full doses of quinine, that is, 
from 20 to 40 grains, ' ' given either at once or within eight or 
ten hours may arrest the disease." (Flint). The physician will 
try, at the commencement, which we call the first stage of the 
disease, to lessen the intensity of the inflammation, to lower the 
temperature of the body, to relieve pain, and to promote toleration 
of the disease in general. After the operation of a saline purgative, 



228 SPECIAL MEDICAL DISEASES. 

if the skin is hot, dry, and the pulse frequent, tartar emetic, or 
some antimonial preparation in small doses as a nauseant or 
sedative are indicated. Tincture of aconite in one or two drop 
doses is an effective sedative in these cases. Opiates are valuable, 
in the first two stages of pneumonia, in doses sufficient to relieve 
the pain and tranquilize the system. Stupes, or warm fomenta- 
tions, applied to the chest, are very useful. If the fever be high 
as shown by a temperature of 103 or more, antipyretic measures 
are indicated. These measures consist in the administration of 
quinine in full doses, acetanilid, antipyrine and others of the same 
class. 

Cold — by means of the bath, the wet sheet, or sponging of 
the body, has the same effect. Whenever, after this object is 
accomplished, the temperature rises, cold is to be applied again. 
It is highly desirable that the employment of these measures be 
under the personal direction of the physician, or an experienced 
assistant and the operations guided by the use of the fever thermo- 
meter. The writer is fully aware that popular opinion is as yet 
strongly opposed to the application of cold in case of fever or 
heat, and patients submit with great reluctance generally at first, 
besides the physician incurs a risk of being blamed if the cases do not 
do well, but it is a safe and ready means of reducing temperature. 
Indeed unattended by any risk, although, from prevalent ideas, 
it seems hazardous in the minds of the laity. "The axiom that, 
patients with fever do not take cold, is one which it is extremely 
desirable should become popularized. Popular apprehension on 
this score often stands in the way of proper ventilation in cases of 
disease. ' ' ( Prof. Austin Flint) . The treatment in the second, 
stage has reference to the promotion of resolution (subsidence of 
the morbid process, to their normal condition), palliation of 
symptoms, and supporting the powers of life. Blisters are not 
advisable, but repeated applications of tincture of iodine or 
turpentine stupes may be beneficial. Expectorants as a rule are 
not indicated, the matter of exudation is not expectorated. The 
expectoration in the second stage of the disease is due to bron- 
chitis in the affected lobe or lobes. The mucous products in 
the grown, rarely accumulate in the bronchial tubes to an extent 



SPECIAL MEDICAL DISEASES. 229 

to occasion inconvenience. The main object of treatment in the 
second stage is to support the powers of life. Resolution will be 
sure to begin and continue if the life of the patient be sufficiently 
prolonged — the chief danger being from failure of the vital powers 
before resolution takes place. Supporting measures should not 
be deferred too long or until the symptoms denote imminent dan- 
ger from failure of the powers of life, as they will probably be 
too late. The supporting treatment embraces nutritious diet, 
alcoholics and tonic remedies. Of tonic remedies, quinine in 2 
to 4 grain doses is to be preferred, repeated every three hours. 
Whiskey or the alcoholics form an essential part of the supporting 
treatment here, as in all other diseases whenever the object is to 
keep alive the patient until the disease has reached the end of its 
career. 

PNEUMONIA IN CHILDREN. 

The treatment of acute lobar pneumonia in children calls for 
the same principals as the treatment of the disease in adults. 
Antimonial preparations, aconite, antipyretic medicines, and opiates 
are alike useful, but must be given with the greatest care. If 
seen at the commencement or within a few hours of the commence- 
ment, an emetic of ipecacuanha may be given. This acts promptly 
as a cardiac sedative — thus diminishing the heat and retards 
somewhat the afflux of blood towards the lungs, and so moderat- 
ing the inflammation, but it should never be employed except on 
the period stated. Heroic treatment in children, is pernicious. 
Many recover with the simplest treatment — mucilaginous drinks 
or mild expectorants, like syrup of squills, or ipecacuanha in 
small doses. Warmth to the chest — with stimulating liniments, 
or turpentine stupes must not be neglected. It is of the highest 
importance to keep the bowels open as a part of the treatment, 
especially in the first stages. Castor oil answers this purpose well, 
or the physician may give a purgative dose of calomel with advan- 
tage. The diet should be nutritious, consisting of milk, animal 
broths and the like, especially after the first three or four days. 
Counter irritation with mustard plasters, or camphorated oil 



230 SPECIAL MEDICAL DISEASES. 

covered with oiled silk is invaluable in the latter stages of the 
disease. A poultice, if the breathing is oppressed and painful, 
applied over the chest, does much good. Stimulation, with carbo- 
nate ammonia, wine or whiskey often becomes imperative. 

ACUTE PLEURISY OR PLEURITIS. 

This is an inflammation of the pluera (the serous membrane 
lining the lungs and chest walls of the breast). While pleurisy 
is a disease of all ages of life, it occurs more frequently in 
grown persons than in children. It is more common in men than 
in women. It is most apt to prevail in the cold and changeable 
weather of winter and spring. It frequently complicates other 
diseases of the chest, like influenza, phthisis, (especially the dry 
form of pleurisy), etc. The invasion is generally sudden, and 
often without premonition. It is sometimes ushered in by a well 
pronounced chill. Pain in the affected side attends the onset of 
most cases. The pain which is usually intense, is sharp, cutting, 
or lancinating in character, being much increased on coughing or 
sneezing. The pain is much increased during the act of inspiration. 
Cough is usually present, though it is sometimes wanting. The 
pulse seldom rises above ioo while the temperature is rarely above 
io2° Fahrenheit. Effusion of serum or water takes place in the 
pleural cavity. 

TREATMENT. 

Morphine, or preferably Dover's powder for the pain. Diu- 
retics like nitre, squills, digitalis, with absorbents, externally 
like iodine, mustard, etc., to remove the effusion. A purge of 
jalap and cream of tartar, will remove the effusion if the other 
means fail. 

PULMONARY CONSUMPTION. 

The names pulmonary tuberculosis and pulmonary phthisis 
are synonymous terms, and are the names by which consumption 
of the lungs is known by the medical profession. It is caused by 



SPECIAL MEDICAL DISEASES. 231 

the growth in the body of a microscopic plant or germ (known as 
the bacillus tuberculosis) which sets up inflammatory conditions 
of the lungs, causing intense cough, fever, wasting, and death in 
man}- cases within two or three years. The germ causes the 
growth in the lungs of little masses known as tubercles, and as the 
disease progresses these soften and break down and are expecto- 
rated by the patient. The expectoration contains millions of these 
minute plant bodies which, when the expectorated matter has 
dried, are set free and are blown about here and there by the 
winds or air currents of houses. They are taken into the lungs of 
some other person by breathing, and if they find a soil suitable for 
their growth, again produce the disease. If we could but destroy 
all these germs which are the sole exciting cause of the disease, 
consumption could be completely stamped out, for there is no 
doubt that it is a communicable, that is, a contagious disease. It 
is timely that the people in general thoroughly understand this 
fact and realize that consumption is communicable and therefore 
Preventable . 

The gravity of the disease should also be fully appreciated. 
Ceaselessly during every hour of time, by night and by day, 
fifteen persons die of consumption in the United States alone ; and 
at least one-seventh of all who die among civilized races die of 
tuberculosis of some form (the disease may affect the brain, 
larynx, peritoneum, coverings of the brain, kidneys, etc., and 
destroy life, without the lungs becoming involved). 

We have become, in regard to this disease, like men in battle 
who see their companions dropping from the ranks with almost 
fatalistic indifference. An every-day occurrence soon becomes 
unnoted. 

Consumption is preventable. — This should be the cry all over 
the land. The exciting cause, as already stated, is positively 
known to be the germ called the bacillus tuberculosis, and with- 
out it the disease could not occur, but there are many predisposing 
or helping causes which enter into the production of consumption, 
and these must not be neglected. The germs are the seeds, but 
like all other seeds they must have a suitable soil in which to 
grow. There are a number of diseases which are likely to be 



232 SPECIAL MEDICAL DISEASES. 

followed by pulmonary consumption, notably among them typhoid 
fever and measles : likewise may it occur after an attack of bron- 
chitis, pleurisy or pneumonia, but these affections are only causa- 
tive in this respect in so far as they tend to debilitate and lower 
the general system, and bring on a cachexia, or bad state of health, 
which favors indirectly the development of phthisis, and not by 
their intrinsic tendency. It consequent^ behooves all those who 
may be so unfortunate as to become ill with these disorders, that 
they exercise particular care and do not neglect to become fully 
restored after such diseases, b}^ the use of the bitter and ferrugi- 
nous (iron) tonics. Under such circumstances, the anaemic 
state certainly favors the development of the germs of this scourge. 
Until recent years it was held that consumption was inherited, 
and, believing this, it was natural that we should fold our hands 
and allow the consumptive-tainted to die. While we know now 
that the disease is not directly transmitted by inheritance (the 
germ does not pass from father or mother to the offspring) there 
is undoubtedly, however, a marked tendency to contract the dis- 
ease when exposed to the exciting cause — the germ, and as the dis- 
ease may develop much more readily in persons of consumptive 
parents, every possible precaution should be taken by such in- 
dividuals to avoid the exciting causes, and so increase all possible 
resistance to the disease. 

No age is exempt from a liability to consumption, but the 
disease is most liable to be developed between the ages of twenty 
and thirty j^ears. As regards season, the disease is oftener de- 
veloped during the spring months and the hot months of summer 
than at other portions of the }^ear. Consumption is largely a dis- 
ease of civilization, due to living in close, poorly ventilated houses, 
filthy cities and amid other unhealthy surroundings. Newly 
settled places are 'frequently to a great extent exempt for some 
time, from its prevalence. It prevails less in climates either 
uniformly warm aod dry, or uniformly cold and dry, than in those 
which are moist and subject to frequent variations. Damp 
soil and damp houses, and all the unsanitary conditions which 
produce lowered health, act as predisposing causes. A high 
altitude affords protection against the disease. It prevails more 
on the seaboard than in inland situations. 



SPECIAL MEDICAL DISEASES. 233 

Certain occupations also tend to produce it. The disease 
prevails much more among those whose pursuits are sedentary 
than among those whose occupation involves outdoor life. Want 
of exercise, defective ventilation, (especially occupations where 
there is constant breathing of foul air filled with irritating dusts) 
deficiency of light, and the depressing emotions undoubtedly con- 
tribute largely to the production of the tuberculous cachexia. The 
influence of these several causes just mentioned is seen even in 
the greater liability of domesticated animals to tuberculous dis- 
ease than of the same animals in a wild or unconfined state. The 
stabled cow, the penned sheep, the tame rabbit, the caged monkey, 
lion, tiger or elephant, are almost invariably cut off by tuberculous 
affections. On the other hand, while certain diseases or con- 
ditions exert an influence to promote the development of tubercu- 
losis, there are affections and circumstances which prevent it. Per- 
sons affected with cardiac lesions which interfere with hsematosis 
(aeration of the blood) rarely become tuberculous. It rarely 
•occurs in people affected with pulmonary emphysema (abnormal 
■distension of the air vesicles). The infrequency with which the 
disease is found in the post-mortem examinations of those who 
lave died from intemperance, has led to the supposition that the 
use of alcohol antagonizes the tuberculous cachexia. Pregnancy 
lias been supposed to antagonize the tuberculous lab it, and mar- 
riage has sometimes been advised as a prophylactic (preventive) 
;and even curative measure, but facts do not afford support to this 
supposition. The writer is of the opinion that lactation greatly 
favors the progress of the disease. Chronic pharyngitis, or 
■catarrh of the throat does not eventuate in consumption or any 
affection of the air passages, and the dazzling advertisements in 
our daily papers by the numerous unscrupulous quacks, who try 
to alarm the people, for mercenary ends should not be heeded. 

HOW PREVENTED. 

In the prevention of pulmonary tuberculosis, we must first 
^consider the destruction of the germ — the exciting cause, which 
w^e find principally in the matter expectorated by consumptives. 



234 SPECIAL MEDICAL DISEASES. 

The germ in the breath of the patient, and in the exhalations or 
excretions from the body, is not communicable except when the 
bowels have become affected and when it maj T be present in the 
stools. Consequently there is no danger in associating with a con- 
sumptive, nor in allowing him to go abroad, if we destroy the 
germs contained only in the expectoration ; and the expectoration 
only becomes dangerous after it has dried and the germs are 
liberated. The best way to destroy the germs is by burning the 
expectorated matter, or by casting it into a solution containing a 
disinfectant, strong enough to kill them. When handkerchiefs 
or cloths are used for the sputa, or when the patient expectorates 
on the floor, or into a dry cuspidor, the germs become free by 
drying, and are blown about the room, settling upon the floor, 
furniture, window ledges, walls, etc. Such a room is dangerous,, 
and especially so if poorly ventilated, and particularly to an} 7 
person predisposed to the disease. It has been positively proven 
that these dried germs will remain alive and active for the produc- 
tion of the disease for several months. With very careless, or very- 
ill and feeble patients, the clothing and bedding may become soiled, 
with expectorated matter, and become a source of danger to others. 
Consumptive patients on the streets frequently, perhaps usually 
expectorate on the ground or pavement, and the germs becoming 
dried may be blown hither and thither, endangering possibly the 
lives of hundreds. In various other ways a person afflicted with, 
consumption, through ignorance or a criminal disregard for others, 
may sow the seeds of death broadcast. While consumption or 
pulmonary tuberculosis, is the most common form of tuberculosis, 
the germ may, however, grow in other parts of the body. Tuber- 
culosis of the bowels is of frequent occurrence, especially in 
children, and is usually produced by eating meat or drinking 
milk from an animal affected with the disease. Tuberculosis 
prevails much among animals, especially milch cows, to an 
unknown but very great extent, so that the danger from this 
source is considerable ; and health authorities should be cordially 
supported in ever} 7 possible effort to prevent the sale of infected 
animal products, and thus prevent the spread of this direful 
disease. There should by all means be special hospitals estab- 



SPECIAL MEDICAL DISEASES. 235 

lished for consumptive patients — where these unfortunate per- 
sons should be kept and treated exclusively ; and I believe the 
time is coming, sooner or later, when such will be the case. The 
individual communion cup should likewise be instituted by our 
church authorities as a preventive measure. 

TREATMENT. 

Consumption in its earlier stages is, in many instances, at? able 
as well as preventable, but the chances of recovery are greatly 
reduced by living in an atmosphere highly infected by the germs 
of the disease, as the patient ma}' reinfect himself. It is conse- 
quent!}' of paramount importance to the patient, as well as to those 
around him, that his infectious expectorations should be promptly 
destroyed. The great and first object of treatment is the removal 
of the constitutional morbid condition — cachexia — on which the 
disease depends. Measures addressed to the pulmonary (lung) 
affections are of secondary importance, as the cough, weakness, etc. , 
are merely symptoms of the disease and not the disease per se. 
The chief end to be kept in view is the prevention of further 
increase of this affection, or, in other words, an arrest of the 
disease. It is immensly desirable for the arrest to take place as 
quickly as possible, while the local affection is limited and the 
pulmonary damage proportionally small ; and with a view to a 
speedy arrest the importance of an early diagnosis can hardly be 
overrated. It goes without saying that the best physician, one 
well up in auscultation and percussion of the chest, should be 
consulted in time. Professor Austin Flint, in his admirable work 
on ' ' Practice of Medicine ' ' says : ' ' The mortality from this 
disease has undoubtedly diminished within the past three decades. 
This must be obvious to medical observers whose professional 
experience extends backward for forty or fifty years. The dimin- 
ution which has already taken place in the death rate from this 
disease, affords ground for the hope that its formidable character 
may be still further mitigated." He further writes: "The 
different modes in which the disease may pursue a favorable 
course have been already stated. The entire deposit may be 



236 SPECIAL MEDICAL DISEASES. 

absorbed or calcification of the caseous products may occur, 
forming the so-called obsolete tubercles or calculi, and these may 
remain quiescent, or they may find their way into the bronchial 
tubes and be expectorated. Cavities ma}- completely cicatrize. 
In these modes complete recover}' may take place. This, of 
course, is the most satisfactory termination. And next to this is 
the persistance of cavities without any fresh products, the cavities 
giving but little inconvenience for an indefinite period, and even 
through a long life. According to these different modes in which 
the course of the disease is favorable, cases ma}' be divided into 
those in which an arrest takes place without recovery, and those 
in which the arrest is followed by recovery. Whether recovery 
follows or not, depends on the extent of the local affection and 
other circumstances. Xot infrequently an arrest takes place, with 
or without recovery, and, after the lapse of months or years, 
a fresh irruption occurs. The latter, then, is not properly a con- 
tinuance of the disease, but a recurrance of it." He further says, 
' ' The disease may cease to progress and end in recovery because 
it is self-limited." 

During a period of thirty-four years this eminent doctor 
treated 670 cases of consumption of which he kept a complete 
record ; of this number 44 ended in recovery and in 31 the disease 
^vas either arrested or ceased to progress. 

All remedies which improve the appetite, digestion, assimila- 
tion and nutrition are in a greater or less degree useful, both as 
to the prevention and cure of phthisis pulmonalis. Hence, 
quinine in tonic doses, salicin, strychnine, the bitter tinctures or 
infusions, the mineral acids, iron with minute doses of arsenic, 
iron aud maltine, or iron alone, cod liver oil, the compound syrup 
of the hypophosphites, etc. , meet indications in cases of this kind. 
Expectorant remedies, as a rule, are not called for. They 
diminish appetite, occasion nausea and are apt to disturb diges- 
tion. But remedies to allay excessive cough, that is, cough not 
required for expectoration, are useful, and for this end small doses 
of the different preparations of opium, like paregoric elixir, give 
good results. The inhalation of the following mixture, by the 
use of a proper inhaler : 



SPECIAL MEDICAL DISEASES. ^37 

R 

Beechwood Creasote, 30 drops. 

Chloroform, 10 drops. 

(Small quantities of terebene, menthol or eucolyptol may 
advantageously be added). 

Inspire deeply, lengthening the pause of the inspiratory act to 
facilitate intra-pulmonary gaseous diffusion. This has a very 
salutary effect on the cough, aside from the germicide, or curative 
virtues which it may possess. 

RULES FOR PREVENTON OF PHTHISIS. 

i. In the house the expectorations of a consumptive patient 
should be received on bits of old cloth or Japanese paper and be 
burned at once, or received in cuspidors or spit-cups containing a 
solution of — 

Labeled f Corrosive Sublimate, one drachm. 
< Muriatic Acid, two ounces. 

y Water, one gallon. 

Keep a small quantity constantly in the spittoons. A solution 
of carbolic acid will serve the same purpose. 

2. The clothing and bedding of the patient should be laun- 
dried separately, and thoroughly boiled. 

3. Sweeping should be done with a dampened broom, or 
wet tea leaves or sawdust on the floor, and the dust removed from 
the furniture, etc., with a cloth, wet with the disinfectant solution. 

4. Dishes, glasses, cutlery, etc. , used by a phthisical patient 
should be scalded before being used again. 

5. It is better for the patient and safer for others that the 
consumptive sleep in a room alone, and especially in a bed to 
himself. 

6. The disease may be transmitted by kissing, especially 
kissing upon the mouth. 

7. Phthisical patients should sleep in well ventilated rooms. 
In conformity with popular notions they are apt to fear the cool or 
cold air of night. 



'238 SPECIAL MEDICAL DISEASES. 

8. A fire may be kept in sleeping rooms in the winter season, 
but the windows should be kept open. Damp houses are injurious. 

9. Be careful to eat all meat cooked well done, as this will 
destroy the germs. Remember that boiling will destroy all germs 
in milk, and young children (who are especially prone to 
tuberculosis of the bowels) should be given only boiled milk. 

10. A mother with consumption should not suckle her child 
as she may infect it through her milk. 

11. Do not move into a house, or sleep in a room in which a 
person has died of or been sick with consumption, until it has 
been properly disinfected. 

12. Avoid as far as possible occupying any length of time 
with a consumptive person, in badty ventilated room, car or 
vessel. 

13. In selecting a mate in marriage, choose one free from 
any inherited scrofulous or tubercular taint. 

14. If of consumptive parents or if a tendency to the disease 
lias been inherited, be specially guarded against all sources of in- 
fection. In addition choose an out door occupation as free as 
possible from dust; use every means to secure a good physical de- 
velopment, particular^ of the chests and lungs ; a course of tonics 
occasional^, especial^ iron and maltine, may be indicated ; select 
a dry soil for a habitation, and have living and sleeping rooms 
freely ventilated and well exposed to direct sunlight. 

15. The bod}^ should be protected against atmospherical 
changes, the temperature and functions of the skin being main- 
tained by warm clothing. This is sound advice to consumptive 
patients as well as to all those who would avoid the disease. The 
garments worn next to the body should be made of a material 
which is a good non-conductor of heat and electricity — namely 
wool. This applies to all seasons of the year. 

Note. — The writer respectfully begs leave, herewith to 
endorse and recommend Dr. Jaeger's Sanita^ Woolen Underwear, 
as the best for this purpose in the market. 






CHAPTER XXI. 

Special Medical Cases. 

Sick Headache and Its Treatment — Convulsions, Epilepsy or Falling Sickness — Hem- 
orrhoids or Piles and How to Relieve Them — Sciatica, Its Cause and Treatment 
— Diabetes and Proper Diet for the Diabetic — Diarrhoea in Grown People and 
Dysentery, and Their Treatment. Bright's Disease — Aphasia — Intermittaut Fever 
or "Fever and Ague," and Malaria, Its Cause, Prevention and Cure — La Grippe- 
Scarlet Fever, Its Origin, History, Prevention and Treatment — Typhoid and Typhus 
Fevers and Asiatic Cholera and Their Prevention — Delirium Tremens, Hysteria, 
Neuralgia, Gastritis, Rheumatism, Nettle Rash, Erysipelas, and Peritonitis and 
Their Treatment— Scabies or "Itch," and Pediculi, or Lice and How to Get Rid of 
the same— Diphtheria and Measles. 

SICK HEADACHE. 

Headache, technically called cephalalgia and migraine, is an 
extremely common affection. Pain in the head is all|i|)sd a symp- 
tom occurring in many diseases ; as in inflammation of the lining 
membrane of the brain; or inflammation of the brain itself; in 
the essential fevers; syphilis; intracranial tumors, etc., but the 
writer wishes to limit this article simply to functional or sick 
headache. There are few persons who do not occasional^ 
experience an attack after childhood or adult age, and there are 
very many who are subject to attacks recurring some times at 
regular, but usually at irregular intervals, for many years, 
or during lifetime. A host of persons suffer from it, who either 
do not consider it of sufficient importance to resort to medical 
treatment, or, having found treatment ineffectual, resign 
themselves to it as an irremediable malady. When it affects one 
side of the head it is usually called hemicrania, (from hemi 
half, and crania, head.) Without nausea or vomiting the affec- 
tion is commonly known as ?iervous headache, and when nausea 



240 SPECIAL MEDIC AE CASES. 

and vomiting occur, it is called sick headache. It occurs in par- 
oxysms, lasting usually from twelve to twenty-four hours, in some 
cases being of shorter duration, and occasionally continuing for 
two or three days. 

The pain in different cases, or in different attacks in the same 
case, differs much in degree. An attack is often not severe 
enough to prevent habitual occupation, but in some instances the 
intensity of the pain is such that the patient is unable to be about, 
and perhaps is obliged to take to bed. The pain is sometimes 
referred to the forehead, sometimes to the back of the head, and 
sometimes to the whole head. The character of the pain as- 
described by patients, differs. It is sometimes sharp or lancinating, 
like the pain in neuralgic paroxysms. In other cases, it is a dull 
heavy pain. Patients sometimes say that they feel as if the head 
would burst. Firm pressure upon the head, especially over the 
temples, often affords momentary relief. Frequently rubbing or 
shampooing the scalp with considerable force diminishes the pain. 
There is frequently an abnormal sensitiveness to light and sounds;; 
and in severe attacks the patient seeks perfect quietude in a dark 
room away from all noise. The appetite during the attack is 
either impaired or lost. The odor of food is often disagreeable. 
The face is in some cases flushed and the eyes suffused, and 
the temperature of the head raised. In other cases, especially if 
nausea and vomiting occur, the face is pallid and the head 
may be cool. Free vomiting, although the stomach may not 
contain any aliment, is sometimes followed by relief. 

Accompanying the foregoing local symptoms, is more or less 
general debility or prostration. There is rarely fever ; the pulse 
is generally small and feeble, and the surface of the body cool.. 
Occasional shiverings are not uncommon. Disturbed action of 
the heart, or palpitation, is not unusual during the attack. 

The attack gradually passes off sometimes with the occurrence 
of free evacuations from the bowels, or an abundant secretion of 
urine, or a profuse perspiration. The attack is apt to be developed 
in the morning, pain being experienced on awakening from sleep, 
and is likely to continue until after sleep is obtained on the 
following night. Persons subject to the affection are able, some- 



SPECIAL MEDICAL CASES. 241 

times, to predict its advent by a feeling of lassitude, depression of 
spirits, or a sense of indefinite discomfort. After the attack has 
passed off, there is frequently, for some time, a sense of soreness 
in the head, with more or less general debility. Often however, 
the mental faculties are clear and the spirits buo3^ant after recovery 
from an attack. 

The affection involves a constitutional predisposition. Per- 
sons are subject to periodical attacks of headache, as of asthma, 
or epilepsy. The predisposition existing, various exciting causes 
may determine an attack : such as mental excitement, deprivation 
of sleep, bodily fatigue, exposure to the sun's rays, and dietetic 
imprudence. Women are more subject to it than men, and it is 
apt to occur at the menstrual period. The predisposition varies 
in degree in different cases, as is shown by the frequency or rare- 
ness of the attacks. The predisposition ceases after the age of 
forty or fifty ; persons who have experienced attacks, more or less 
frequently, from adult age up to the periods of life just named, 
thereafter are exempt from their recurrence. This may be stated 
as a rule, but unhappily, there are not a few exceptions. 

The affection is neuralgic in its character, but it is difficult to 
determine its precise seat. It is not an incongruity that anemia 
and congestion alike may give rise to the cephalalgia. 

TREATMENT. 

Periodical headache, as regards successful treatment, belongs 
among the opprobia of medical art ; yet in a great many cases, 
much benefit may be derived from treatment. The treatment 
embraces measures to be employed at the time of an attack, and 
during the intervals. If patients be not unpleasantly affected by 
opiates, an attack may be sometimes warded off, or abridged, or 
its severity lessened, by a full dose of opium in some of its forms, 
or of its alkaloids, morphia or codein. The carbonate of ammonia 
and also the aromatic spirits of ammonia are sometimes successful 
in affording relief. A saline purgative, taken at the commence- 
ment of tbe attack, is in some cases an effectual remedy. The 
bromides given in full doses are sometimes efficacious. The fol- 

17 



242 SPECIAL MEDICAL CASES. 

lowing prescription, which you can have put up at any drug store, 
is the best remedy in the writer's long experience, that he can 
ernplo} r , viz. : 

B 

Bromide ot Potassa, one ounce. 

Deodorized Tincture of Opium, six drachms. 
Add water enough to make the mixture three ounces. 

Dose. — Shake and take a teaspoonful in a little sugar water 
every hour until relieved ; one dose being often sufficient. Anti- 
pyrine in five to ten grain doses is likewise a good palliative. 
This statement will also apply to the hydrate of chloral, in doses 
of fifteen grains, repeated once or twice after an hour's interval, if 
relief be not obtained. 

Various palliative measures may be resorted to with advantage. 
The inhalation of a little ol the vapor of chloroform is sometimes 
an efficient palliative. Evaporating lotions applied to the head such 
as alcohol, spirits, vinegar, ether, etc., in some cases afford 
marked relief. A napkin or towel wrung out in water as hot as 
can be borne, and wound around the head, is more efficient than 
cold applications in some cases. Warm stimulating foot baths are 
useful. Strong coffee or tea afford marked relief. The inhalation 
of nitrite of amyl often immediately relieves an attack of headache. 
Klectricit}'- has been found effective in arresting and preventing the 
recurrence of the paroxysms. The electrial treatment should not 
be abandoned until after a fair trial of the faradic and the galvanic 
current. 

During the intervals, remedies which are sometimes useful, 
by way of prevention and towards improving the digestive organs 
are, nux vomica or strychnia in small doses, arsenic, small doses 
of quinine, (especially when of neuralgic origin), belladonna and 
the preparations of zinc, more especially the valerianate. A very 
valuable stomachic like the compound tincture of gentian with a 
few drops of dilute nitro-muriatic acid, or the tincture of quassia 
during the intervals will often lessen the liability to headache by 
improving digestion. These remedies ma}?- be tried in succession. 
Hygienic measures are important. In general terms, the liability 



SPECIAL MEDICAL CASES. 243 

to attacks is less, the more the laws of health are observed. When 
habitual constipation exists that matter should receive proper 
attention, and the reader is referred to the chapter treating on this 
subject. 

Avoidance, as far as possible, of everything which experience 
shows, in individual cases, to act as exciting causes, is an important 
part of the rule to be observed by the patient during the intervals. 
I have very often, permanently cured sick headache with tincture 
of quassia, in teaspoonful doses given before meals, as well as by 
five grain doses of quinine just before eating. Tincture of cannabis 
indica in thirty drop doses three tines a day, taken for some time 
will also succeed in effecting a cure. 

CONVULSIONS, EPILEPSY OR FALLING SICKNESS. 

Convulsions or " fits," as the}' are often called, are a frequent 
cause of alarm in the streets, or at public assemblages. In the 
decided majority of instances, the convulsions may be safely 
presumed as epileptic ; so unless otherwise specified, the remarks 
here made apply to that form. Ordinary fainting may be con- 
founded with it ; but here the face is pale, the person perfectly 
still, and there is no perceptible breathing' Besides, in fainting 
there are no convulsive movements. Often the epileptic seizure is 
ushered in with a peculiar sharp cry, as the person falls over. It 
does not always occur, but when it does there can be no doubt, if 
it is a convulsion at all, that it is epileptic. There is frothing of 
the mouth, sometimes tinged with blood from the tongue or a fold 
of the lips having been caught between the teeth at the moment the 
spasm commenced in the muscles of the jaws. Sometimes there 
are general convulsive movements of the whole body ; often of 
parts of it onl} 7 . At first the face is pale, but usually, in the 
course of a few moments, it becomes livid, except around the 
mouth, which often continues pale, in strong contrast with the 
rest of the face. As a general rule, it may be said that the. con- 
vulsive feature of the attack does not last much longer than four 
or five minutes, although to bystanders the time naturally seems 
longer. Then the person opens his eyes with a certain degree of 



i 



244 SPECIAL MEDICAL CASES. 

intelligence, or revives enough to speak ; and, as will be said, it 
is at this point of the attack that most must be done. Sometimes 
there is nothing beyond it, and the individual gets up, hurriedty 
puts on his hat, and walks off, apparently the least concerned of 
anybody about. 

If this happy termination does not take place, this brief, semi- 
conscious interval gives way to a heavy stupor, varying in duration 
from thirty minutes to three or even six hours. 

In epileptic convulsions, there is usually nothing to be done. 
Ignorant people on such occasions are apt, upon the general plea 
" if you do not know what to do, do something," to insist upon 
"opening the hands," as the phrase is, saying that the patient will 
be better as soon as he can do it. The truth is, they can not do it 
until the patient is better. All interference of this kind is hurtful, 
and no good can come of it. All rude efforts aggravate the 
trouble, perhaps, by exhausting still further the muscular strength 
of the patient. All that can be done is to keep the person from 
injuring himself or hurting others during the violent convulsive 
movements, by removing him to some clear space where there is 
nothing to strike against. Do not attempt even to hold the 
limbs, but loosen everything about the throat and chest. 

TREATMENT. 

Wait a few minutes for the convulsive movements to cease,, 
and the semi-conscious state to appear. As said above, it will 
soon be seen. Then, if the person is a stranger, get his name and 
residence, if possible, with such other knowledge as may be useful. 
In the meantime, keep the crowd away. This is a very important 
measure of assistance in convulsions, as in every other emergency. 
By this is meant that people should not bend over the victim,, 
but that a perfectly free space of at least two feet on each side 
should be kept, with none in it but the one or two immediately 
assisting him. 

Thirty drops of the aromatic spirits of ammonia in a teaspoon- 
ful of water, may be given the patient, as it is thought by many 
physicians to lighten and shorten the later stupid stage. The 



SPECIAL MEDICAL CASES. 245 

spasmodic condition of the muscles of the jaws can usually be 
overcome enough, with a little gentle dexterity, to permit it to be 
got into the mouth with the assistance of another spoon or a piece 
of smooth stick. After getting the liquid into the mouth, press 
down the base of the tongue, and the mixture will readily run 
down the throat. As much of it will necessarily be lost during 
the operation, double the quantity may be prepared for use. If 
more than the thirty drops should be given, no trouble from it 
need be feared. 

If the name and residence have been secured, as it often can, 
at the interval alluded to, the friends of the person can be advised, 
If not, he should be taken to some place of security until con- 
sciousness returns. Persons liable to epileptic convulsions should 
never be permitted to go from the house without a strip containing 
the name, residence and disease, attached inside of the coat, 
where it will at once be seen upon unbuttoning the coat over the 
chest. A reference on it to a memorandum in some pocket con- 
taining a suggestion as to the duration of the attack, useful 
remedy, if an}', in assisting restoration, would often materially 
add to the comfort and advantage of the afflicted person. Other 
convulsions are apoplectic. These are not common, in comparison 
with others. As a rule, little can be done by bystanders, further 
than loosening everything about the neck. This should be done 
in all convulsions. The convulsions known as hysterical are 
usually found in the young women who are not very strong. 
Until assistance comes, act as directed in epileptic convulsions. 
The distinction between them can not be expressed, to a useful 
extent, to unprofessional persons. The foregoing management 
or treatment of epileptoid convulsions is calculated to be only 
applicable while the fit exists or lasts. But the writer has had very 
great success in curing this dreadful disease in a number of cases, 
while he has likewise failed to permanently benefit others. Yet 
he wishes to put himself on record as saying that the complaint is 
not so hopelessly incurable, but that all so afflicted should avail 
themselves of efforts to obtain judicious treatment at the hands of 
skilled physicians, as a great many become permanently relieved. 
Indeed where the cause can be discovered and removed a cure is 



246 SPECIAL MEDICAL CASES. 

sure to follow. The bromides of potassium, ammonium, sodium,, 
and lithium, together with sulphate of strychnia, cannabis indica, 
atropia, and picrotoxin are among the valuable remedies in this 
disease. The writer further solicits this class of patients, and 
will promptly answer all communications on this subject. 

HEMORRHOIDS OR PILES. 

There are few maladies more common than this, and few 
which are more annoying. Piles consist of tumors formed within 
the rectum and about the anus, by dilation of the hemorrhoidal 
veins and thickening of their walls. It is literally a blood flow, 
and is very common, generally affecting persons of indolent habits 
who sit a great deal, especially on soft warm seats or cushions ; 
resulting of ten from costiveness, sometimes aggravated by looseness, 
straining too much at stool, or remaining too long at stool, 
pregnane}', or whatever else may cause congestion, or too much 
blood flowing into the small blood vessels on the inner side of 
the lower end of the rectum, causing the sides of these little 
blood vessels to distend or bulge out, as the blood is more and 
more crowded or wedged in, making little knobs, sometimes 
inside, sometimes outside, called internal and external piles ; 
when these little knobs burst, they are called bleeding piles ; 
if they do not, "blind piles," these latter are the most painful, 
for the bleeding ones relieve themselves. After stooling, the 
finger ends should be placed on the parts, and pushed upwards as 
the patient rises, so as not to have the pile caught on the outside 
of the purse-string-like apparatus, of the parts, for then it will get 
larger and more painful as more blood accumulates in it, while 
none can return in consequence of the construction. 

Whatever tends to favor an undue accumulation of blood in 
the hemorrhoidal veins predisposes to piles. For this reason, the 
affection is frequently a result of diseases of the heart and liver, 
which cause an obstruction in the circulation of the blood through 
the portal vein. Pressure from tumors in the abdomen, or an 
enlarged or misplaced uterus, is not unfrequently a cause of the 
disease b} 7 keeping the hemorrhoidal veins over-distended. 



SPECIAL MEDICAL CASES. 247 

TREATMENT. 

All cases of piles are not amenable to the same form of treat- 
ment, for various unhealthy conditions of the S3^stem are often 
concerned in their production and perpetuation, which must, of 
necessity, be remedied by appropriate treatmeut, before a cure of 
the piles can be expected. It is therefore, apparent that the 
avoidance of causes, which are apt to produce this trouble is of 
paramount importance. In conducting the treatment of a case of 
piles, that surgeon or physician will succeed best who looks upon 
the disease, not as a local affection, requiring merely external 
treatment, for it should be viewed as a symptom, but rather an 
effect of some remote obstruction and disease of some internal 
organ, like the liver or the circulation in general, the remo\al of 
which will usually alone be sufficient to accomplish its cure, with- 
out the necessity of local interference. When habitual constipation 
is the cause, medicines which correct that disorder as recommended 
in the article on that affection, will generally suffice to cure this 
trouble. 

The following prescription is also an excellent remedy in all 
such cases, viz. : 

R 

Fluid Extract Cascara Sagrada, two ounces. 
Comp. Tincture of Gentian, two ounces. 

Dose. — A teaspoonful or less before meals to regulate the 
bowels. 

When the hemmorrhoidal tumor or tumors are so situated that 
they can be removed with the knife or scissors, that is the best and 
quickest way to get relief. Ointments made with the extracts of 
stramonuim, belladonna or opium in vaseline, and mixed with 
astringents like powdered galls, etc. , especially when used in bleed- 
ing piles, are very soothing and beneficial. The parts should also 
be regularly sponged with cold water, to which carbolic acid may 
be added, morning and evening. Where the parts discharge, itch, 
or become irritated, there is nothing so palliating as the benzoated 
oxide of zinc ointment, to which a few drops of carbolic acid may 



24:8 SPECIAL MEDICAE CASKS. 

beneficially be incorporated, and applied three times a day. This 
ointment can be procured at any drug store. It is also the very 
best application for chafing, which is so frequent and distressing 
during hot weather, in those who are obliged to walk a great deal, 
particularly stout people. 

SCIATICA, ITS CAUSE AND TREATMENT. 

This is a disease characterized by severe pain, of a neuralgic 
nature, running along the course of the sciatic nerve. It is in 
most instances due to a neuritis (inflammation) of the nerves or of 
its cords of origin, but it may be only a fimctional disorder of the 
nerve and its branches. It occurs most frequently in men ; 
rheumatism is present in many cases. Exposure to cold, particu- 
larly after heavy work, or a severe wetting, is a common cause of 
this complaint. Pain is the most constant and troublesome symp- 
tom, which as a rule, sets in gradually, and for a time may be 
slight and confined to the back of the thigh or upper leg. At the 
beginning, there is often fever or heat. Soon the pain becomes 
more intense, and, instead of being limited to the upper portion of 
the nerve, extends down the thigh, reaching to the foot, and 
darting over the entire distribution of the nerve. The patient 
can often point out the most sensitive spots, and on pressure these 
are excrutiatingly painful. The pain is described as gnawing or 
burning, and is usuall} T constant, sometimes in paroxysms, and 
frequently worse at night. In long continued cases there is 
wasting of the muscles. Its duration and course are extremely 
variable. It is often an obstinate affection, lasting for months. 

TREATMENT. 

When rheumatism is the cause, the salicylate of soda, together 
with other anti-rheumatic remedies, as suggested in another part 
of this work, should be employed. If there is a syphilitic taint, 
the iodide of potassium must be given. Antip3 T rine, antifebrin and 
quinine have been highly extolled in this disease. Prof. Weir 
Mitchell, of Philadelphia, very highly recommends, rest in bed 



SPECIAL MEDICAL CASES. 249 

with fixation of the limb, by means of a long splint, like in frac- 
tures, as a most valuable method of treatment. Prof, Pepper has 
relieved, and in some instances completely cured, obstinate 
and protracted eases which resisted all other treatment. Local 
applications of warmth; a liniment of tincture aconite, chloroform 
and tincture opium are highly beneficial. Deep injections of 
morphine, into the nerves gives great relief, and is sometimes 
curable, as experienced by the writer. But morphine is a dangerous 
remedy in sciatica in one respect. The disease is often so pro- 
tracted, so liable to relapse, and the patient's morale so under- 
mined \>y constant worry and sleepless nights, that the danger of 
contracting the morphine habit is indeed great ; and as simply 
distilled water, injected in the same manner, will very often relieve 
the pain equally as readily, the morphine should be employed with 
the greatest circumspection. 

DIABETES AND THE PROPER DIET FOR THE DIABETIC 

The term diebetes means simply an increased flow of urine 
(diuresis) . There are two forms of this disease , diabites insipidus — 
where the quality of urine passed is large, sometimes enormous- 
ly so, of a pale limpid appearance, like pure water, of a low 
specific gravity, but containing neither sugar nor any abnormal 
constituent. In this form, the health is seldom notably disorded. 
The appetite and digestion may be unimpaired, the functions 
generally are well performed, and the body does not waste. The 
condition may occur in early life or become developed at any age. 
It may occur and last but a while or continue for an indefinite 
period or during life. It does not tend to lead to any disease, is 
not serious, aside from the annoyance and debility which it oc- 
casions. 

DIABETES MELLITUS. 

The other form of the affection, which is also characterized 
by an excessive amount of urine, of a high specific gravity and 
the presence of grape sugar or glucose ; hence the term mellitus, 
which signifies honey or sugar. The disease is not of frequent 



250 SPECIAL MEDICAL CASES. 

occurrence, yet it is not so rare but that we should not learn to 
thoroughly understand how to treat it when it becomes uecessary 
Sugar in the urine, may occur as a symptom in various conditions, 
where it is usually not abundant and the urine containing it for a 
short period only. Even when the affection exists permanently, 
it is merely a symptom and does not constitute the affection, and 
with our present knowledge, the true seat and nature of the 
disease are not known. 

Symptoms. — Targe increase of urine, is usually the first sign 
which awakens suspicion of the existence of the disease. The 
urine is generally clear, as well as pale and is deficient in color in 
proportion to the amount of sugar it contains. The presence of 
sugar is perceptible to the taste and attracts flies and bees if emit- 
ted on the ground. The increase in the quantity of urine is 
generally very great, and sometimes enormous. It may amount 
to thirty pints, or even more, in the 24 hours. Exceptionally the- 
quantity of the urine is not increased, although abounding in 
sugar. It is accompanied by voracious appetite, great thirst, and 
progressive emaciation and enfeeblement. Pulmonary tubercu- 
losis is apt to develop during its course. 

TREATMENT. 

The essential treatment of diabetes is dietetic. The object is 
the exclusion, as far as possible, of sugar and starch from the 
diet. Frequently all evidence of the disease disappears under 
strict dietetic treatment, and the patient is apparently in perfect- 
health. The bill of fare for diabetes is very extensive. Al 1 
varieties of shell-fish are allowable. Soups without flour, fish, 
poultry and game. Salads made of lettuce, celery, cucumbers, 
water cress, dandelion, young onions, and cabbage. In the fruit 
line, sour apples, lemons, sour oranges, strawberries, and currents. 
Eggs, cheese, butter, buttermilk, cream, milk in moderation, un- 
sweetened jellies and all nuts may also be eaten. Of drinks, 
coffee, tea, and cocoa without sugar, whiskey, brandy, gin, and 
claret are permissible. Glycerine may be used, in place of sugar 
in coffee and tea. The interdicted kinds of food are, sugar. 



SPECIAL MEDICAL CASES. 251 

syrups of all kinds, and honey, wheat and rye flour and corn 
meal, arrowroot, sago, tapioca, oatmeal, barley, potatoes, beets, 
parsnips, rhubarb, carrots, peas and beans, chestnuts, sweet 
potatoes, sweet fruits ot any kind, cider, chocolate, malt liquors, 
all the sweet wines, sweetened spirits and liquors. In ignorance 
of the pathology of diabetes, we have no rational indications for 
drugs. Opium or codeine valerian, the alkalies, cod liver oil, 
arsenic and iodide of potassium, are among the great number of 
remedies recommended. 

Tonics like iron and small doses of strichnine should be given 
when anaemia and want of appetite call for this class of medicines. 
Hygieneic observances are of the greatest importance in this af- 
fection. 



DYSENTERY AND TREATMENT. 

This is an inflammatory disease of the large intestine, 
characterized by frequent passages of blood and mucus, with 
rectal tenesmus (straining) and pain. The caecum, colon and 
rectum are the parts most involved. People of all ages are liable 
to this disease, but the majority of patients are adults and under 
thirty. It is most apt to prevail during the months of July, 
August, September and October. The most frequent cause of 
dysentery, is sudden change from warm to cold, which checks 
the perspiration, and causes a determination of blood from the 
surface to the internal organs. The sudden exposure to cold 
when the body is heated, is a great danger to which child? en are 
especially liable, on account of the easy disturbance of the circula- 
tory system in themselves, unless incessantly watched — hence the 
frequent bowel complaints in children. 

Fecal accumulations as well as worms have been known to 
produce severe dysentery in children accompanied by the character- 
istic straining at stool and the muco-bloody passages — ceasing 
as soon as the offending substances were expelled. The use of 
unripe or stale fruit and the accumulating of their seeds in the 
bowels may all be sufficient cause to produce this affection. 



252 SPECIAL MEDICAL CASES. 

TREATMENT. 

If there is any reason to suspect the presence of any irritating 
substance in the intestinal canal, it is very advisable to commence 
treatment by the use of some simple evacuant, like castor oil. 
This applies to children and grown persons alike. After this, our 
main reliance, so far as internal medication is concerned, must be 
on opiates, or opiates with diaphoretics (medicines producing 
perspiration) . One of the foremost remedies of this class is Dover's 
powder, which may safely be given to a child five years old, in 
doses of three grains every two or three hours ; to adults, in six 
to eight grain doses. The occasional administration of a laxa- 
tive is of the greatest value in this affection and should not be 
neglected ; they are especially indicated if the stools are entirely 
or mainly consisting of blood and mucus. 

The dose should be merely sufficient to produce a fecal 
evacuation, but repeated as required, daily or less frequently. 
The laxative commonly preferred is Rochelle salts or castor oil. 
The physician may advantageously prescribe an opiate (like pare- 
goric) mixture, containing sufficient of the laxative (especially if 
castor oil be chosen), to have the effect desired. After the active 
inflammatory stage has passed, if there is still looseness of the 
bowels, it can readily be controlled by the use of astringents (like 
catechu kino, tannin, krameria, etc.) combined with opiates, 
prepared chalk or sub nitrate of bismuth. When the stomach is 
irritable, or when tannic acid and like unpleasant medicines are 
desired to be given, it is often best to administer the same per 
rectum, in the form of injections or suppositories, especially in 
children. Applications of sinapisms (mustard plasters) followed 
by warm applications to the abdomen, are very beneficial, particu- 
larly in children. Tincture of camphor will often produce sufficient 
counter-irritation without the use of mustard. If, in children, 
convulsions threaten, a~ mustard foot bath repeated occasionally 
will usually tranquilize the nervous system and avert the danger. 

The diet must be bland and unirritating. In the first stages, 
barley water, or arrow root, boiled in water and similar drinks 
should constitute the main diet. When the active inflammation 



SPECIAL MEDICAL CASES. -553 

has lessened or abated, or at any period of the disease, if there are 
signs of. prostration, more nourishing food should be given, such 
as milk, pigeon broth, etc, Alcoholic stimulants are required in 
all protracted cases where symptoms of exhaustion exist or threaten. 

DIARRHCEA IN GROWN PEOPLE! — TREATMENT. 

The term diarrhoea is used to denote a condition characterized 
by loose and frequent evacuations of the bowels. It may be due 
to irritant substances, as undigested food, overpurging from, 
cathartic drugs, special kinds of drinking water, bacteria, etc. 
Diarrhoea is also a symptom of inflammation of the large and small 
intestines, and of certain structural lesions, as in typhoid fever and 
tuberculosis. I shall limit my remarks, in this article, to diarrhoea 
as a functional affection, that is, as not dependent on inflammation, 
or any appreciable lesion or structure. As a functional affection, 
it may be either transient or chronic. A diarrhoea is said to be 
simple or fecal, when the passages consist of feces not changed in 
character, but simply morbidly soft or liquid. Bilious when from 
their yellow or green color, bile is present or supposed to be present 
in larger quantity than usual Diarrhoea is serous or watery, when 
there is an abundant discharge of liquid, and dysenteric or mucous, 
when slime is present in the dejections. The passages are called 
crapulous w T hen they contain undigested food ; this form of diar- 
rhoea, is met especially in children. We also have /#//}' diarrhoea, 
where free fat or oil, is found in the evacuations. Diarrhoea is 
most apt to occur during the summer season. This may be, 
explained in part, by the larger proportion of fruit and vegetables 
eaten and by the effect of heat in weakening the digestion. 

TREATMENT. 

Removal of the cause of itritation, as undigested food by 
castor oil, a mild purgative in fact, is generally prescribed with 
advantage in diarrhoea, as retained or hardened feces are likewise 
often the cause of the affection. If, after the bowels have been 
freely evacuated, either of their own accord, or by a laxative, the 



254 SPECIAL MEDICAL CASES. 

diarrhoea, pain, or uneasiness continue, the same call for a mild 
anodye (a medicine to relieve pain) for example, a teaspoonful or 
two of paregoric, in chalk mixture, a grain of opium, a sixth or a 
quarter of a grain of morphine in mint water, or six grains of 
Dover's powder, or thirty drops of laudanum together with astrin- 
gents like tincture of catechu, krameria, etc. Whatever remedy 
chosen must be repeated after several hours, if necessary. Intesti- 
nal antiseptics to prevent putrifaction or fermentative changes, like 
salol, very small doses of carbolic acid, salicylic acid and bismuth 
are invaluable. The diet for a day or two should be very simple 
and restricted. Chronic diarrhoea is best treated, by pernitrate of 
iron, large doses of sub-nitrate of bismuth and pepsin, in conjunc- 
tion with regulation of diet and all measures to improve digestion. 

BRIGHT' S DISEASE. 

Bright' s disease (so called after Dr. Richard Bright, of London, 
who was the first, in 1827, to write about this affection), is a name 
applied to any disease of the kidneys with albuminuria (albumen in 
the urine) and general dropsey. Bright' s disease is b}^ medical 
writers regarded as a nephritis, (an inflammation of the kidneys). 
This inflammation always affects both kidneys, but one organ may 
be more affected than the other. Bright' s disease is divided into 
two forms — an acute and chronic. The diagnosis of this disease 
is readily made by any ordinary physician, by the chemical 
examination of the urine, which always contains albumen in con- 
siderable, and frequently in great abundance. The tests for 
albumen are made by either adding nitric acid to the suspected 
urine by heating the same in a test tube, over a spirit lamp, which 
if albumen be present, will at once show a white color or precipi- 
tate, corresponding in thickness according to the quantity of 
albumen present. This disease may occur at any period of life, 
(young infants or children are not exempt from it, but in this 
class of patients, it occurs in the acute form only and is a sequel of 
scarlet fever, which is readily amenable to judicious treatment). 
The description of this article relates to the chronic form of the 
affection only. The disease occurs much oftener in males than in 



SPECIAL MEDICAL CASES. 255 

females. It sometimes occurs during the development of consump- 
tion, and the albuminuria and dropsey in pregnancy depend, in a 
certain proportion of cases, on this affection. It occurs especially 
in persons addicted to drinking ; but in these eases it may be 
difficult to say how much of the causative agency is to be attributed 
directly to the action of alcohol, and how much to the exposure 
incidental to intemperance. It is observed frequently to become 
developed after lying on the ground in a state of intoxication. 
Medicines like copaiba, turpentine and spanish-flies, if taken in 
excessive doses, or too long continued, as in the treatment of gon- 
orrhoea, ma}- cause the affection. The immediate danger in cases 
of this complaint is from uraemia (blood poisoning by absorbtion of 
urea, the poisonous element in the urine), which may cause coma 
and convulsions. Dropsical effusions into the pleural cavities may 
also take place to such an extent as to destroy life. 

TREATMENT. 

There are three leading objects of treatment : i. To lessen 
the intensity of the renal inflammation, promote resolution, and 
restore the secretory function of the kidneys. 2. To lessen or 
remove the dropsical effusion and, 3. Elimination of urea through 
the skin or bowels if uraemia exists or be threatened. 

Carefulness as regards diet, exercise, and exposure to cold, is 
important. Tonic remedies, especially preparations of iron, are 
generally needed. The form of iron, known as Basham's mixture 
is particularly well suited in this class of cases. 

With reference to the first object, rest and warmth of the 
surface are indicated, which necessitates the patient to remain in 
bed Allow water and other bland liquids as freely as the thirst 
dictates — with nourishing but unstimulating diet. Cupping — 
perfectly dry — over the loins or kidneys is the best method of re- 
vulsion or counter-irritation. Warm fomentation over the regions 
of the kidneys are likewise useful. With reference to the 
dropsey, either saline cathartics or the more active hydragogues 
(purgatives producing watery stools) are required in proportion to 
the amount and situation of the dropsical condition or effusion. 



256 SPECIAL MEDICAL CASES. 

For these ends eleterium, gamboge, the active principal of 
may apple (podophilin) , and jalap with cream of tartar are efficient 
remedies. Diuretics are not to be relied on ; the kidneys will not 
be likely to respond to them, besides they are hurtful on account 
of their inflamed condition. But digitalis with the saline class of 
diuretics are often useful. 

APHASIA, ITS DEFINITION AND CAUSE. 

The term aphasia, is derived from two Greek words, (a and 
phasis, signif3 T ing a ' ' sa3 T ing ' ' ) and consists in an impairment in 
the expressing of ideas, either by speech or b}^ writing. The 
motor or ataxic form is due to lesion of the third (left) frontal con- 
volution of the brain, while the sensory form is due to lesion of 
the first and second temporo-sphenoidal convolutions. This 
affection follows attacks of cerebral apoplexy, caused by plugging 
of a vessel, especially an artery, in the brain, called cerebral 
embolism. Such a plug is named an " embolon " or " embolus," 
and is brought from some point remote from the site of obstruction. 
It may be single or multiple, and consist of fibrin, fat, masses of 
bacteria, or air bubbles. This obstruction is called thrombosis, and 
the thrombus or obstruction produces pressure on the nerve centres,, 
thereby producing paralysis. 

Aphasia is to be distinguished from aphonia, a term denoting 
inability to speak in consequence of either laryngeal disease or 
paralysis of the laryngeal muscles. 

Aphonia is the loss of the voice, and aphasia is the loss of 
speech ; the former relating exclusively to the vocal organs, the 
latter proceeding from a cerebral affection. In aphasia the patient 
is mute from an inability to use words expressive of the ideas 
which are in the mind. The loss of speech may be complete or 
partial ; the patient in some instances is absolutely dumb. Some- 
times a single word can be spoken such as " yes " or " no," and 
this is uttered whenever the attempt to speak is made. In other 
instances the command of words is larger, but limited to a few 
words, and in different cases, we find every degree of incompleteness 
in the aphasic condition. The difficulty of speech may consist in. 



SPECIAL MEDICAL CASES. 257 

which wrong words are substituted for the right ones, or the words 
be arranged so as to form meaningless combinations, which is 
distinguished as paraphasia. In ataxic aphasia the mind may 
recognize the proper signification of words, the difficulty consisting 
in the inability to give expression to the words. As the name 
implies this inability proceeds from a want of power to co-ordinate 
the muscles concerned in speech. In amnesic aphasia there is 
inability to recollect words as the symbols of ideas — language is 
lost to the memory. In purely ataxic aphasia, the ability to use 
language correctly in writing is not lost, and may not be impaired, 
provided, the intellectual faculties are intact. In this form, the 
ability to read is retained, and language spoken by others is com- 
prehended or understood. So far as can be judged, in some cases 
of ataxic aphasia absolute mutism is not incompatible with undi- 
minished intelligence. Frequently, however, the cerebral affection 
which causes the aphasia, impairs, in a greater or less degree, the 
mental faculties. In amnesic aphasia, on the other hand, the loss 
of speech is accompanied by inability to use written language 
(which is called agraphia). The person may understand both 
spoken and written language. Inability in these respects involves, 
in a greater or less degree, mental imbecility (a weakness of the 
mind bordering on idiocy). In ataxic or the motory form, the 
ability to interpret signs or gestures is preserved. If this be lost 
in either forms of aphasia, there is imbecility in a greater or less 
degree. Patients affected with ataxic aphasia, even when it is 
evident that the intelligence is well retained, cannot repeat words 
after dictation. Patients with purely amnesic or sensory aphasia 
are able to do this, provided the intelligence is not too much 
impaired. These two forms of aphasia may be associated ; the 
patient can then express ideas neither by spoken nor w T ritten 
language, and is unable to repeat words after dictation. Prof. 
Flint, says : " In cases of either ataxic or amnesic aphasia, it is 
not an easy problem to determine whether or not, or to what extent, 
the mental powers are impaired. This problem is sometimes pre- 
sented to physicians in medico-legal cases. The instances must be 
rare in which persistent aphasia, associated with hemiplegia, 
(paralysis of one side of the body) , does not involve more or less 

18 



258 SPECIAL MEDICAL CASES. 

impairment of mind. Ataxic aphasia, as an isolated affection, may 
exist with the intellect apparently unaffected. It is doubtful if 
this can be said of amnesic aphasia. Words are the instruments of 
thought as well as the expression of ideas, and it is difficult to believe 
that the inability to recollect words is possible without deterioration 
of the reasoning faculties. The inability to understand spoken 
or written language and signs, is proof of impaired intellect." 

TREATMENT. 

In the young, associated with hemiplegia, from whatever cause, 
it is usually transitory, and they quickly learn to talk, perhaps by 
education of the centres of the opposite side of the brain, but in 
adults the condition is much less hopeful, especially, in cases of 
complete motor aphasia with right hemiplegia. Though now and 
then recovery is rapid, in others partial recovery occurs and 
the patient is able to talk, but misplaces words. If motor aphasia 
has persisted for three or more months without improvement, the 
condition generally remains hopeless and the patient may remain 
speechless — though understand everything that is said. The 
education of an aphasic person demands the greatest patience and 
we must begin as with a child — commence with detached letters, 
afterwards words with one syllable etc. When the right side is 
paralyzed, the patient may be taught to write with the left hand, 
and have a medium of communication. 

Note. — Amnesic pertains to loss of memory, particularly an 
impairment in the expression of ideas, due to a failure to remember 
the right words. 

PRACTICAL OBSERVATIONS ON MALARIA AS CAUSED BY CONTAM- 
INATED WATER AND INTERMITTENT FEVER OR 
FEVER AND AGUE. 

Intermittent fever, popularly known, as "fever and ague," 
"chill fever," "the shakes," and, by names expressive of the 
locality in which it is produced, as, in Iyouisiana " swamp fever," 
1 ' Panama fever, ' ' etc. , is too well known by the general reader to 



SPECIAL MEDICAL CASES. 259 

need a lengthy definition. I shall, therefore, mainly consider, its 
•cause, prevention and treatment. There are three simple types of 
intermittent fever, namely, the quotidian, where the paroxysms 
take place daily, as the name implies ; the tertian, where the par- 
oxysms recur on the third day, or at about forty-eight hours, and 
the quartan type, or where the paroxysms take place on the fourth 
da}', the interval being about seventy-two hours. The latter form 
is comparatively rare. Attacks may occur at any hour of the day, 
but rarely take place during the night. In a large majority of 
cases the paroxysms occur before noon. During the intermission, 
there is much difference, in different cases as regards freedom from 
ailments. In some cases the patient complains only of a certain 
amount of weakness ; the appetite and digestion are good, and 
there is no perceptible disorder of any of the functions, in others 
marked prostration, loss of appetite, etc. , exist. The disease shows 
no preferance for either sex and it affects all ages. Facts abund- 
antly prove that it is not communicable from one person to another. 
The malarial fevers being purely miasmatic. 

Causation. — The doctrine that, intermittent and remittent 
fevers, are produced by a special morbific agent, commonly known 
as malaria, is no longer doubted. But a great diversity of opinion 
seems to exist or spring up as to the mode of its introduction into 
the system ; formerly, it was generally held, that this germ, or 
miasm, producing malarial poisoning, floated in the atmosphere 
and was thus inhaled into the system, and that this was the chief 
if not the only source of its introduction. In lieu of this proof, is 
cited the fact that persons sleeping in an upper story escape this 
marsh miasm, while those sleeping on a level with the ground 
become afflicted. The same theory teaches that it is more abundant 
in the night-air than during the day — that the malarial contamina- 
tion may often be avoided by avoiding exposure in the evening, 
night or early morning. But recent investigations prove conclu- 
sively, that all malarial diseases have their source in contaminated 
drinking water. Dr. W. H. Daly, an eminent physician, of 
Pittsburg, Pa. , in an able article read before the American Clima- 
tological Association, in Washington, D. C, in May, 1894, sa Y s 
upon this subject, which he undoubtedly thoroughly investigated : 



1 



260 SPECIAL MEDICAL CASES. 

' 'The writer has for the past twenty or more years spent probably- 
an average of two months annually in tl^e recreative sports of the 
field, forest, and stream. The largest proportion of these holiday- 
jaunts have been passed in the lowlands, or in the swamps of the 
lake-sides or sea-side, in the pursuit of wild-fowl shooting.. Many, 
if not most of these regions were, and are generally admitted to 
be, intensely malarial in character, notably the vast Kankakee 
swamps in Indiana. 

"In former years, before the writer had noticed certain con- 
ditions, and used certain precautions, he was subject to malariaL 
disease of a continuous or recurrent type, clearly traceable to his 
having drunk the shallow well and swamp water of these regions. 

" Observations and studies on the subject, and investigations 
made in various districts from Manitoba to Louisiana, and all along 
the southern coast of the Atlantic Ocean, and of Cuba, Yucatan, 
and other districts of Mexico, lead the writer to the conclusions 
that so-called malarial disease is not easily, if at all, contracted by 
inhaling so-called malaria or bad air, of the low, swampy, or new 
lands, but it is distinctly, if not almost exclusively, due to drink- 
ing the water that has come into contact with, and become infected 
with the malarial germs or infusoria that exist in the earth and. 
waters of the swamp and lowlands. This germ does not ordinarily, 
if at all, float in the air during the day, nor does it find easily a 
vehicle in the fog or vapors of the night. 

"Indeed it is difficult to understand how one is to avoid the 
night-air, even if it is conceded to be deleterious — a conclusion I 
much doubt. Does any other air exist at night ? Is it possible to 
breath any other? Is there any habitation sufficiently sealed 
against the outside air to make the breathing of outside night-air 
impossible ? 

"I understand the United States Navy Department years ago 
made, and they may still, for aught I know, make, a point of 
advising the anchorage of war vessels in streams and waters of 
malarial districts so as to avoid the air currents from the swamps 
near by, lest the air, laden with poison, should be inhaled by the 
officers and sailors. 

"I will venture to say that no air from the foulest swamp can 
be more deadly than the foul air that is produced by the emanations- 



SPECIAL MEDICAL CASES. 261 

from the air passages, and from eifete matter from human beings 
crowded into the hold of a ship. That sort of air is indeed malarial, 
while the swamp air I believe to be comparatively safe and whole- 
some, but of the swamp water beware for any other purpose 
than ablution. 

"I am fully aware that in taking the ground I here occupy I 
may be considered to be too radical, and that my position may be 
regarded as untenable. If so, I can only answer that every 
observing medical man must and is bound to tell honestly and 
fairly what he has gathered from his own experience, observation, 
and studies, and it must be considered that my observations have 
been prolonged, extensive, and fairh" intelligent, and made not, 
so to speak, second-hand, but personally and upon the ground in 
districts distinctly malarial, and that during the years that I and 
-others had been careful to avoid the mists and fogs of the malarial 
Tegions, as well as the out door night air, but all the while using 
the surface swamp, or shallow well waters for drinking, I, as well 
as others of my friends, suffered from malaria, so called ; but 
later on, and during the past twelve years, while abstaining from 
drinking the surface or well water, and with the utmost freedom 
of exposure to the out door night air, fogs, rain, and mists at all 
times, night and day, we have enjoyed complete immunity. 

"Whoever has shot w 7 ild foul knows full well that the best 
opportunities come to a sportsman amid storm and rain, with the 
•early mists of the morning, and when the marshes are redolent 
with the vapors of the evening, just at nightfall, when the wild 
foul are flying to and fro, seeking their favorite haunts in the 
marshes to sleep. 

"Then there is the journey of miles homeward to the club- 
louse, farm house, or camp, in the small ducking-boat, that brings 
one to the fireside possibly not earlier than eight to ten o'clock at 
night, so that exposure is positive, and close to the marsh and 
-water, as one is sitting in a small boat. 

"I mention the foregoing as relevant, since medical men 
are still the readers and learners from the classic text books of 
Watson, Tanner, and Niemeyer, not to speak of many others. 

"Tanner says, in his most attractive style : 'It is worth 
remembering that malarial districts are most dangerous at night, 



262 SPECIAL MEDICAL CASES. 

and that this poison lies low, or, as Dr. Watson sa}^s, ' ' loves the 
ground. ' ' And Dr. MacCullach says : '" It is a common remark in 
many parts of Italy, that as long as laborers are in an erect position 
they incur little danger, but that the fever attacks those that sit 
on the ground." ' 

"All the older and most of the new text books lay stress upon 
the strict^ malarial feature of the disease, that is to say, that 
the poison is breathed into the system. Some of the newer writers, 
it is true, give some prominence to the source of contagion, from 
drinking the infected land or swamp-water, but still adhere to the 
belief in the medium of the air as a chief or equal source of 
infection. This latter belief is a gross fallacy in my opinion, and 
will not stand the test of practical proof, if the factor of drinking" 
land and swamp-water is eliminated. 

"In recent years, through the digging up and renewing of the 
aqueducts, which for centuries had supplied the city of Rome with 
drinking water, it was discovered that many of her wealthy and 
leading citizens had, during the period of her grandeur and deca- 
dence, actually been guilty of clandestinely draining the sewage 
from their country and suburban villas into the very aqueducts that 
supplied the city and their fellow citizens with drinking water. 

"Can there be a greater example of public degradation, and 
can any evidence be stronger than this, that a larger part of the 
Roman fever, which is unmistakably malarial, has been due to 
contaminated drinking-water rather than the infected air ? 

"As I say, during these earlier years that I and others of my 
sportsmen friends drank freely from the running brooks and streams 
and from the swamps, we also endured for the sake of the sport of 
shooting wild fowl, an occasional shake with the ague and many 
of the other disagreeable symptoms that, while they do not amount 
to an actual chill, make one feel about as wretched as it is possible 
for one to feel and go about. And I and the others were all the time 
taking heavy doses of quinine as an antidote. In fact, no trip was 
ever taken to the swamp for wild fowl without plenty of quinine 
and a little whisk ey. 

"But during the past twelve years, and since we have avoided 
drinking the surface-water, and, when it was possible, even the 



SPECIAL MEDICAL CASES. U63 

deeper well-water of the region except after boiling the same, I 
have been quite free, as have been others of my friends whom I 
have advised. 

"If one cannot get boiled water an}^ other way, it is well 
enough to take the water that has been boiled by a brewery, viz: in 
form of beer. 

"It is now generally conceded that the malarial germ is the 
cause of the fever. Lemaire, Klebs, Crudeli, and others have 
isolated certain forms of bacillus, which they believe to be specific 
of malaria. Laveran first, and Richard and Marchiafava, and Cella, 
also found in the blood three forms of protozoa, one of which par- 
ticularly produced intermittent fever by inoculation. The germ is 
infusorial, and exists in the water and soil. 

"E. Maurel, in the Semaine Medicate, (Annual Universal 
Medical Sciences, 1888,) announced to the French Association for 
the Advancement of Science, that it is always easy to distinguish 
a health)- from a malarial soil. 

"The water from the malarious districts always contains 
numerous micro organisms, some of which are possibly L,averan's 
corpuscles in an early stage of their development, but it is not yet 
certain that the germ has been isolated outside of the human body. 

"In regard to the real value of Laveran's corpuscles in the 
production of malaria, he himself believes them to be indirectly 
concerned in the production of the infection, although their relation 
to it has not absolutely demonstrated. It is probable, according to 
Rougette, (L' Union Medicale) that the malarial microbe gives 
rise to symptomatic fever by reason of its activity in producing 
leucomaines. During the access of fever the microbe is eliminated 
by natural emunctories. 

"The liver is a destroyer of leucomaines; (Annual Universal 
Medical Sciences, 1888) but, as my paper is upon the question of 
the manner in which the so-called malarial infection enters the 
human body, whether through the air- passages, or the digestive 
tract by means of drinking-water, I must not wander into other 
phases of the subject. I am firmly convinced that farther investi- 
gation will as surely lead us to the knowledge that so-called 
malaria is, strictly speaking, a water-borne disease, as it is that 



264 SPECIAL MEDICAL CASES, 

we are now being lead to the right conclusion, by Ernest Hart and 
others-, that cholera is also a water-borne disease ; and it is our 
duty to educate the profession, and the public, especially those who 
make up the population of the malarial districts, that it is the 
water they drink, and not the air they breath, that decides whether 
they will suffer from malaria or not. 

" It is a great pleasure to have come into contact with many of 
the intelligent medical men, who practise in the southern end of 
malarial districts of our country, whose beliefs are far in advance 
of the vague and obsolete views of many of our writers of text- 
books. If there were as many such men in our profession as there 
ought to be, the use of quinine as an antiperiodic would soon 
become unnecessary. In fact I regard the malarial type of fever, 
in the United States at least, as clearly preventable as any other 
disease that we have to deal with, and by the simple method of 
drinking only carefully collected uncontaminated rain-water, 
which, as a simple precaution, might be boiled. 

' ' I have observed on some of the plantations of the South, that 
among certain cattle and horses that have been shipped from the 
North for breeding purposes, many of those that were turned out 
on the marshes to drink the surface-water sooner or later sickened 
and died with what was known as climatic fever (malarial) ; but 
the animals that were kept stabled, and drank only the deep well 
and cistern- water, would thrive as w T ell as they did in the North. 

" In the British Medical Journal of October 21, 1893, Oswald 
Baker, surgeon of the British Army, writes that on the steamer 
Scindia, which sailed from Bomba3 T for Marseilles on August 5, 
1893, there occurred several cases of acute malarial fever that were, 
from the account given by Mr. Baker, clearly traceable to the 
drinking-water, which was taken on the ship at Bombay, and not 
in any wa}^ due to the air that the patients breathed. 

"It is a pleasure to note in the medical journals — the great 
educators of those who write text-books — the accumulating testi- 
mony of careful observers, who agree with my observations and 
experience herein set forth. 

" In the Medical Record of January 28, 1893, E. D. S. writes 
that five out of a family of six, adults and children, had suffered 



SPECIAL MEDICAL CASES. 265 

pretty continuosly for the past six years with malaria (so diag- 
nosticated by the best physicians) , at times quite seriously ill, with 
temperature 104 F. Quinine was administered. Seven months 
ago a Pasteur filter was introduced, and quickly every symptom 
of malaria disappeared. Another family had the same experience. 

"Dr. L. L. Von Wedekind, U. S. Navy, in the Medical 
Record of February n, 1S93, gives a history of some cases which 
indicate that to drinking the land-water was traceable the cause of 
malarial fever on the coast of southwestern Africa. The doctor 
says ' that land- water is considered as a cause, and a prominently 
exciting cause, with naval medical officers,' as is proven by the 
orders issued by medical officers of the different ships serving on 
the coast, prohibiting the use of native water for drinking purposes. 

"In the region about Elizabeth, N. J., some years ago, in 
conversation with some well educated medical men — among others 
Drs. W. J Lumsden and Oscar McMullen, who were and are 
careful observers, I learned that their outbreaks of malarial fever 
(fresh cases) usually occurred in the early autumn, following a 
period of rainfall and a few subsequent warm days, but new cases 
only occurring among those who drank the land- water. 

' ' The inhabitants who used the storm-water, carefully stored 
in clean cisterns, especially above ground, uncontaminated with the 
soil water are immune from the attacks, and while the disease 
during the past two years has presented some varying features to 
these gentlemen, such as catarrhal jaundice, of an endemic char- 
acter, traceable to malarial influence, as well as other forms, there 
does not appear to be anything to controvert the evidence that these 
patients took their malaria in water, either as drink, or upon the 
•leaves of the turnip-top, greens, kale, spinnach, cabbage, or other 
vegetables that grow close to the ground and have surface water 
on their leaves. These vegetables are abundant and usual in the 
culinary supplies of the region. 

" One may ask, why do not New Yorkers and Philadelphians 
also get malaria from the same surface-water, dew, and moisture 
upon the leaves of these small vegetables, shipped from this pro- 
ductive region to those cities? The answer might well be that 
•they do unless the leaves are well washed in uncontaminated run- 
ning-water before being presented for use as table food. 



266 SPECIAL MEDICAL CASES. 

" Dr. R. E. Boyken, of Smithfield, Isle of Wight County, Va. r 
informed me that thirty years ago he had studied this subject, and! 
had since induced as many of his patients and fellow-citizens of 
his county as possible to adopt the cistern water as a beverage, 
and all those families who fell in with and followed out his views 
are of healthy and ruddy complexion and free from malarial disease 
while those who continued to drink the land- water are subject to- 
attacks of malarial fever. 

" That so-called malaria is an autochthonous disease, finding 
its way into the human body through the food channels, there can. 
be little or no doubt in the mind of the original and unfettered- 
observers. 

" It is true we have not found what we know to be the malarial 
germ and isolated it outside of the human body, and we are not. 
sure either that we have found the typhoid germ in the soil or in. 
the suspected drinking water ; yet we are quite sure that we trace 
typhoid origin through these sources. 

" Let us eliminate the atmospheric factor in malaria by noting 
in each case if the soil, surface, or shallow well-water has been, 
drunk by the patient. If this has been done, the case is obviously- 
one that has been exposed to the infection in its most potent form- 
There can be no scientific question more strictly in line, and touch- 
ing the true object, of this learned Association than this, and it is 
to be hoped that in the future papers will be invited from those 
who have had an opportunity of observing data bearing upon this, 
the chief phrase of this unsettled question. 

1 ' We do not merety want a rehash of old dogmas from the 
text-books, or echoes from time-worn unfounded opinions, garbled 
by one so-called authority from an antecedent authority, but let us 
have the fresh and unbiased observations and views of the thousands 
of intelligent medical men who have the opportunity in their own. 
neighborhood to make original observations and report them. 

" Dr. W. J. Lumsden, of Elizabeth, N. J., recently wrote me 
that his case-books show that fully ninety- eight per cent, of patients 
who have suffered from malaria for the past ten years got their 
supply of drinking-water from the dug wells of the region Those 
inhabitants who used the water from driven-wells, thirty or more 



SPECIAL MEDICAL CASES. 267 

feet deep, have had an unmistakable improvement in health. A 
driven-well is made by driving an iron pipe with a perforated inlet 
down deep into the earth, through strata of clay or marl, which 
seals off the surface land-water. So it will be understood that the 
water from the driven-well is pretty securely sealed against surface- 
water by its small calibre and tight fit in the soil through which it 
penetrates. 

' ' Since writing this article I observe the growth of medical 
opinion is gaining strength along the lines and in the direction of 
the contention of this paper. The Journal of the American 
Medical Association, of May 12, 1894, contains the following : 

" ' Dr. Richard H. Lewis, of the North Carolina State Board 
of Health, has prepared a circular letter for the medical men of his 
State, regarding the influence of well-water in the production of 
fever and ague. He gives a homely illustration in the recited 
history of two families who resided as next-door neighbors in one 
of the eastern towns of his State. The two families each contained 
two adults — father and mother — and seven children. The two 
families w 7 ere friendly, but their homes were sufficiently separated 
to require independent water-supplies for each. One family drank 
from what was regarded with pride as ' ' the best well in town, ' ' the 
other of rain water caught in wooden tanks. The members of the 
first family were constantly sick with malarial disease of one kind 
or another. Those of the second never had even a chill.' 

" It is the wish to build up a line of testimony of like character, 
if such can be obtained through the medical men of North Carolina, 
To this end he has written the appended letter, giving an invitation 
to a co-operative study of the well-water origin of malarial 
diseases. 

' ' ' Dear Doctor ; The evidence that malarial diseases are 
introduced into the system in many, if not most, instances through 
the medium of drinking-water, is to my mind conclusive. The 
water containing the germs, or plasmodia, is surface or superficial 
soil-water. Those living in malarial districts who confine them- 
selves to water from cisterns or wells driven or bored beneath the 
stratum of marl or impervious clay — in other words, beyond the 
water which soaks down from the surface — are to a large extent 



268 SPECIAL MEDICAL CASES. 

free from attacks. If the people of our eastern counties could be 
generally convinced of this fact, and thereby induced to act upon 
it, the health conditions of that really fine section would be revo- 
lutionized for the better. To bring this about is the object of the 
Board of Health. In order to do this, facts must be presented to 
them in the concrete — not by illustrations fron 'Asia and Spasia 
and t'other side o' Hillsborough,' so to speak, but by instances 
from among their own neighbors. I write to ask you if } r ou know 
an} T facts bearing on this subject, and if so, that you will write them 
to me in detail at your earliest convenience. Give me the name 
and post-Office of the head of the family having the experience. 
If not personally familiar with the facts, send me the name and 
address, that I may write to him direct.' " — New York Medical 
Record. 

, TREATMENT. 

In the salts of quinine, medicine possesses specifics for the cure 
of the malarial type of fevers, as well as for all affections caused by 
malarial poisoning, if any remedies can be entitled to this appel- 
lation. Quinine or sulphate of cinchonidia will prompt^ check the 
recurrence of the parox3 T sms of intermittent fever, provided the 
preparation of the drug employed is properly administered and is 
not spurious or adulterated. The disease should always be arrested 
as speedily as possible, as its morbid effects are always less in 
proportion as it is quickly arrested, and the liability to relapses 
thereby very greatly diminished. Formerly it was customary to 
prepare the system for quinine or other special remedies, by 
mercurial cathartics, emetics, and even blood-letting sometimes — 
measures which were all injurious to the S3' stem, aside from the 
delay in arresting the disease which they caused. There is no 
need of preparatory treatment. Begin with abortive remedies at 



once 



With reference to the time of giving the anti-periodic remedy, 
my experience has led me to the conclusion, in fact thoroughly 
convinced me, that it proves most effective when given as near to 
the paroxysm which has passed as possible. As regards doses, 



SPECIAL MEDICAL CASES. 269' 

and successive doses, the most effective plan is to give the remedy 
so as to produce evidence of cinchonism (buzzing of the ears, etc.,) 
as speedily as possible. This object may be accomplished by giving 
a single dose, that is in quantity of twenty grains, or by somewhat 
smaller and repeated doses. The latter method is by far the better 
way of successfully checking the paroxysms of fever and ague, and 
the reader is respectfully referred to the article on qiiinine in 
another chapter of this book, for formula and further advice as to 
treatment of this and other affections due to malarial poisoning. 
Some persons do not bear such heroic doses, of the salts of quinine, 
to whom the remedy must be administered in smaller doses. 
Chinconism is the test in this respect. The co- existence of any 
other affection does not contra-indicate the plan of treatment 
described here. In young children, owing to the difficulty of 
giving this class of medicines by the mouth, the remedy may be 
given per enema (injection into the rectum) . In such cases it may 
also effectively be employed by inunction, an ointment containing 
the quinine being rubbed into the arm-pits, groin and over the 
abdomen. 

The hypodermic injection maybe resorted to in cases of inter- 
mittent fever, when the remedy is not retained by either the stomach 
or rectum. This mode of administration has the advantage of 
economy as regards the quantity of quinine required, as the method 
has been fully tested and observations proven that the effect is 
three or four times greater when thus administered than when 
taken into the stomach. Besides the effect is also more quickly 
induced. But the writer would caution against the employment 
of the ordinary salts of quinine for this purpose, as there is con- 
siderable risk of abscesses forming at the places where the injections 
are given. The remedies for hypodermic or subcutaneous injec- 
tion, for this purpose must be especially prepared — be absolutely 
pure and perfectly soluble, in an equal weight of water. 

There are several succedania (substitutes) of the preparations 
of cinchona which are capable of arresting the disease ; like salicin,. 
sulphate of bebeerine (this one eminently so), ferrocyanide. of iron, 
chloride of sodium, piperine, arsenic (which ranks next to quinine 
in value, the form Fowler's solution being generally employed),. 



270 SPECIAL MEDICAL CASES. 

muriate of ammonia, pilocarpin, strychnia and others. During the 
hot stages relief is obtained by sponging the body with cold or 
warm water, together with ice-water drunk freely. During the 
sweating stage, comfort is procured by wiping the body with warm 
flannels, changing the linen and bedclothes. After perusing the 
foregoing, the reader need hardly be told that the best preventive 
against malaria is carefulness in drinking-water. 



EA GRIPPE. — ORIGIN, HISTORY AND TREATMENT. 

This disease which is quite well understood by the general 
reader, at this time, has received many names, the most common 
being influenza and la grippe. The term influenza was applied to 
the affection by the Italians, in the seventeenth century, upon the 
supposition that it owed its origin to some occult influence of the 
stars. La grippe is said to come from the Polish Crypka, signify- 
ing ' ' hoarse, ' ' others recognize it in the French word, ' ' gripper ' ' 
which means "to seize." The Germans call it " blitz katarrh. " 
The disease is sometimes called "Russian influenza," because it 
is supposed to have had its origin in Siberia. It usually occurs 
as an epidemic and travels very rapidly over the globe. The dis- 
ease probably prevailed extensively from the earliest ages, but 
accurate descriptions of the disease date back only to the beginning 
of the sixteenth century. Since then there have been frequent and 
extensive epidemics, many of which have spread rapidly over 
both continents, and have appeared almost simultaneously in 
widely separated countries. Repeated outbreaks, of this affection, 
have occurred in America, since at least 1875. The last great 
epidemic, which is no doubt remembered by many readers of this 
article, occurred in 1889, and seems to have started or broken out 
at Bokhora, Asia, in the month of May, 1889. It na( i established 
itself in St. Petersburg, in October of the same year, and was 
recognized in Paris, as early as November. England was invaded 
about the same time, if not a little earlier. It spread very rapidly 
to this continent ; cases began to be of very frequent occurrence, 
and the epidemic reached its height at almost the same date in 



SPECIAL MEDICAL CASES. 271 

.January and February of 1890, in widely separated localities 
throughout the entire United States. 

It smouldered away during the ensuing summer, only to 
awaken or break out with renewed activity in the late autumn of 
that year, prevailing extensively again in the following spring ; 
.and for a third time, but in milder and less prolonged from in the 
winter of 1891-92, etc., the disease is beyond question infectious 
and highly contagious, and spreads by atmospheric influences as 
well as by contact — that is from person to person. It attacks 
persons of all ages and conditions. Young children are, however, 
less frequently and less seriously attacked than older persons. On 
the other hand, the aged and infirm, and persons of nervous tem- 
perament and in those whose vitality is depressed by over-work 
and anxiety, are especially liable to the disease. The bacillus of 
influenza seems to act specifically upon the mucous membrane of 
the respiratory tract with which it comes in contact ; and is received 
into the s} T stem by means of the inspired air. Humidity of the 
atmosphere seems to favor greatly the development of the affection. 

The temperature noticed in the various localities where this 
pandemic fever prevailed ranged from ioo° to 105 Fahr. , and 
usually remained at this height for two or three days, and subsided 
rapidly, the fibrile movement being symptomatic. I^a grippe is 
also analogous to the epizootic that frequently prevails among 
domestic animals — especially the equine family. The exact nature 
of these infectious diseases is however, not established, with 
accuracy ; nor is the evidence clear as to this transmission to the 
human subject, nor as to the acquisition by animals of influenza 
from man. 

Symptoms. — So varied are the signs in different cases of 
Influenza that it is difficult to present a brief sketch of its symptoms. 
In all epidemics there are many cases of a type so mild that the 
patients pay little or no attention to the attack, regarding it as an 
ordinary catarrhal cold, and continue their usual occupations. 
The main features in the majority of cases, are chills, which are 
quickly followed by heat or fever, sneezing and coughing, together 
with headache and pains in the back . There is depression of spirits 
with pain in the flesh and a general weakness, corresponding with 



272 SPECIAL MEDICAL CASKS. 

the severity of the attack. Sore throat and pain in the chest are 
seldom absent in the catarrhal or pulmonary form. Perhaps 4a 
per cent, of these catarrhal cases of la grippe have a typical pneu- 
monia ; severe cough, with shortness and tightness of breathing, 
is often present ; soreness about the eyes ; ' ' snuffles ' ' and all the 
symptoms of a " bad cold ' ' is the usual order of things. The 
pulse ranges from 90 to 120, usually full in volume, although in 
many cases it gets small and weak. The pain in the chest is some- 
times very severe. The throat maj^ become very sore, swollen and 
covered with exudations. The bronchitis is frequently grave. 
Ear-ache is often a prominent symptom. In the gastric (where 
the stomach is affected) form of the disease, there is usually nausea 
and vomiting — sometimes very persistent. Loss of appetite prevails 
in nearly every case. Among the numerous affections which follow 
la grippe ; may be mentioned, alopecia (falling of the hair), erysipe- 
las, and consumption. The mental derangements, insanity, etc., 
usually pass away after the patient is convalescent. Epidemic 
influenza, if not properly managed, is indeed more Hable to serious 
complications than nearly any other disease we know of. Catarr- 
hal affections of the nose and throat not infrequently follow this 
affection. 

TREATMENT. 

This disease by proper treatment at the beginning of an attack 
can be so modified as to be almost aborted. But if not properly 
managed, influenza is particularly liable to grave complications. 
Even in mild cases the tendency is towards prostration, and fre- 
quently the nervous shock is such as to materially debilitate the 
patient. Quinine is undoubtedly, the best germ destroyer we have 
for the microbes of influenza. The following formula is of tested 
value in these cases ; the relief -obtained from the administration 
of antikamnia where the headache is severe is often wonderful : 

R Quinine Sulphate, ^ drachm. 

Antikamnia, y% drachm. 

Salol, ]/ 2 drachm. 

Mix. Make fifteen powders, one every two hours. (For a 
grown person. 



SPECIAL MEDICAL CASKS. 273r 

Antifebrine, antipyrine, or acetanilid, are all invaluable agents 
in this affection, but should be prescribed by direction of a physician. 
A ten grain dose of antikamnia, (alone) will often act very hap- 
pily in these cases, especially where there is much pain. Quinine,, 
as an abortive remedy, should be given in five to ten grain doses, 
three or four times a day. Mustard pediluvia (foot baths) are of 
great advantage, and a plaster of mustard and lard, one part of the 
former to two parts of the latter, applied directly to the chest, is a 
splendid mild counter-irritant. Expectorants or cough medicines 
are often needed, and the following mixture which contains anti- 
kamnia also, is well suited in these cases : 

R 

Antikamnia, one drachm. 

Syrup Senega, one ounce. 

Wine of Ipecac, four drachms. 

Syrup Tolu, nineteen drachms. 

Dose. — A teaspoonful every two hours. 

Quinine in tonic doses is greatly indicated in most cases ; say 
in pills of two grains every two hours, during the course of the 
disease. Where there is much pain in the back, chest and limbs, 
Dover's powder, in five grain doses, repeated every few hours, 
affords much relief. Headache may be palliated by cold applica- 
tions to the head, and small doses of phenacetin, in place of 
antikamnia. Where the nose symptoms are very prominent or 
troublesome, nothing affords quicker or better relief than a 4 per 
cent, solution of cocaine, introduced high up in the nasal passages. 
Great care in clothing in the avoidance of damp air or draughts 
and of any sudden check of perspiration, should be strictly observed. 
Confinement to the house, or rest in bed, in severe cases, must be 
insisted on from the onset, until fully recovered. During conva- 
lescence all details of personal hygiene, with nutritious diet, etc. , is 
of especial importance. A course of the vegetable and iron tonics 
is indeed indicated in most cases after influenza, as this disease 
tends greatly to leave the system in a weak and debilitated condi- 
tion and thus favorable for the development of tuberculosis, etc. 

19 



274 SPECIAL MEDICAL CASES. 

SCARLET FEVER. — ITS ORIGIN, HISTORY, PREVENTION AND 

TREATMENT. 

The term scarlatina is derived from the Latin, and the affection 
is so called on account of the scarlet or beautiful bright red eruption 
which accompanies it. 

The disease is of three varieties — scarlatina simplex, in which 
the throat symptoms are slight or entirely absent — scarlatina 
anginosa, in which the throat symptoms, are very severe and the 
characteristic eruption often slight — malignant scarlatina in which 
the symptoms such as fever, delirium, restlessness, sleeplessness, 
etc., are very severe, the prostration very great, and the compli- 
cations especially as regards the throat, very marked. 

Scarlet fever appeared in England, in the j^ear A. D., 1661, 
but from whence it was originally imported is unknown. 

Medical literature states that it was afterwards recognized in 
Scotland, in 17 16 ; Germany and Italy, in 17 17 ; Denmark, in 
1740 ; North America, at Kingston and Boston, in 1735 ; New York 
and Philadelphia, in 1746 ; Ohio and Kentucky, in 1791 ; Toronto, 
in 1843 ; New Orleans, in 1847, and in California, in 185 1. 

The disease according to medical writers is rare in Asia and 
Africa and is said to be entirely unknown in Japan. 

This affection does not seem to have been of such virulent and 
malignant a nature as now, when it first made its appearance in 
England and on the continent, for Sydenham, the celebrated 
English physician, who was the first to recognize and describe it 
(in 1661) as we now know it, considered the disease " only an 
ailment ' ' writing ' ' we can hardly call it more. ' ' The affection 
was in its earliest times very frequently confounded with measles, 
as much and more so perhaps as it is confounded in our time with 
diphtheria. 

The disease often prevails epidemically and epidemics are 
known to differ greatly in severity and fatality, some being 
extremely mild while others are unusually severe and the number 
of deaths fearfully great. Soil, season, or climate offers no expla- 
nation of this peculiarity ; and we remain as yet, entirely ignorant 
of the cause or conditions which determine these remarkable diver- 



SPECIAL MEDICAL CASES. 275 

-sities of phenomena and danger. Thus it may be said that while 
small - pox has been shorn of its terrors (through vaccination) 
scarlet fever takes rank as the most dreaded of all the infections 
which now prevail. It is indeed a lamentable fact that the laity 
understand comparatively little about the contagiousness or the 
sources of propagation of such highly infectious and contagious 
diseases like scarlet fever, diphtheria and small-pox, and the means 
whereby their spread or communicability may be avoided or pre- 
vented. For if the proper precautions were taken or observed 
these scourges could be exterminated or completely eradicated from 
our midst, and it is indeed timely that the people in general should 
become better educated and more fully acquainted on this all- 
important subject. The writer is of the opinion that the proper 
place to begin this education is in the school-room, and would 
suggest that our text books used in our public schools, be profuse 
with this class of literature instead of the stories and fiction which 
they now so largely contain. The susceptibility to scarlatina is 
much less than to measles and small-pox, one member of a large 
family being often alone attacked. Hence a great number of 
people escape it throughout life. Again individual families, (not 
unlike as in pulmonary consumption) seem predisposed to, or 
exempt from the disease. But it is difficult, with our present 
knowledge, to find any explanation for this individual or family 
immunity or susceptibility. 

It is principally a disease of childhood, as statistics show con- 
clusively that sixty per cent, of cases occur before the age of five, 
and ninety per cent, under ten years. Attacks later in life are 
rare, and are usually mild. One attack confers immunity, as a 
rule, for life. Scarlatina is undoubtedly contagious, and very 
highly infectious. Every case owes its origin to a previous case. 
The disease never originates de ?wvo or anew, and is dissemi- 
nated and conveyed by contact direct or indirect, eminently by 
clothing, washing, bedding, furniture, letters, books (as from a 
library or school), toys, etc. Convalescents from the disease carry 
it to school, church, theatre, train, etc., and in this way dissemi- 
nate it throughout a community. The cause of the disease is said 
to be disseminated from the skin as well as the various secretions, 



! 



276 SPECIAL MEDICAL CASES. 

and during all stages of it. But it is perhaps most dangerous 
during the desquamative stage, as the many thousand particles of 
dead skin, perhaps floating in the atmosphere are thus inhaled in 
the lungs and in this way propagate the disease readily. Daily 
ablutions or washing the child with warm water, sufficiently disin- 
fected or carbolized will lessen the danger from this source of infec- 
tion very materially and should be much encouraged. The disease 
may likewise be conveyed by third persons, carrying the poison in 
their hands, hair or clothing, who may themselves remain exempt. 
If the public better understood the circumstances governing these 
ills, there is no doubt their conduct would frequently be very differ- 
ent in these matters. Physicians too should often exercise more 
care than they generally do in regard to the spread of this fearful 
scourge. In the light of existing knowledge no doctor or surgeon 
in attendance upon a case of any infectious disease, like scarlet fever 
or diphtheria, should attend another case, or enter another house- 
without previous thorough disinfection. The disease may lurk in 
houses for a great length of time, and the health authorities should 
always see, after a case or cases of this nature have existed in a home, 
that all the clothing, bedding and the whole house be thoroughly 
disinfected after the disease is ended. A not infrequent source of 
infection is milk, from an infected dairy, or otherwise. The only 
safeguard against these germs is boiling the milk before use. 

TREATMENT. 

The treatment of scarlet fever is mostly directed according to 
symptoms, as medical science has not as yet discovered a specific, 
like we possess in quinine in the treatment of the malarial type of 
fevers. The sick-room requires constant good ventilation from 
the outside air. The temperature of the bed-room should be main- 
tained at from 65 ° to 70 F. as registered by a thermometer, at the 
head of the bed. The little patient should wear a long muslin 
night-dress, without other clothing. The bed-covering must be as 
light as is consistent with comfort. Milk and meat soups form the 
best diet. Water, carbonated water, seltzer, apollinaris, lemonade, 
toast- water or barley-water, should be given freely to relieve the 



SPECIAL MEDICAL CASES. ' .277 

thirst and to keep the kidneys and skin active, in order that these 
channels may eliminate as much of the scarlatinous poison as 
possible. 

Drink should be offered once an hour, in high fever, during 
the day. Rigid cleanliness is to be maintained by frequent spong- 
ing and bathing of the surface. 

Daily luke-warm baths (full length) give the greatest comfort 
throughout the disease. Temperature above 103 F. is best com- 
bated with cold sponging, cold packs or cold baths, but as popular 
opinion is as yet opposed to such procedures, and under such 
circumstances, I would recommend tepid baths, to which a little 
vinegar or baking-soda ma} 7 advantageously be added. Where 
these ablutions or baths cannot be employed, resort may be had to 
the antipyretics, antipyriue, antifebrine, phenacetin, etc., in proper 
<loses for children, as suggested in the article on bodily temperature. 
Phenacetin is the least injurious and should always be preferred 
for children. Burning and itching of the skin are best allayed hy 
the application, after warm baths, of vaseline, goose-grease or fresh 
lard, to which a few drops of carbolic acid may advantageously be 
mixed. Quiet, peaceful, and more or less restorative sleep is wont 
to occur after a bath and inunction in this way. 

Nervous distress, restlessness, convulsions, insomnia, head- 
ache, etc., are best combated by bromide of potassium or sodium 
in doses of from five to ten grains (according to the age of the 
child) largely diluted and sweetened. The writer has seen very 
.happy results from the use of hydrate of chloral, in five grain doses 
in obstinate cases of this kind in children. Indeed no other 
single remedy gives the comforts of chloral in repeated doses of 
two to three grains. Small doses of Dover's powder are sometimes 
a good substitute. Ice - bags should be applied to the head for 
brain symptoms. The vomiting, which is sometimes intense, is 
best relieved by doses of two to five grains of chloral, in a little 
peppermint- water. This remedy may be administered per rectum 
in double doses ; throat symptoms call for inhalations of steam, 
best from steam vaporizer, either simple or medicated, with boric 
acid, three drachms to four ounces of water. A little carbolic acid 
and glycerine are equally suitable. Ear-ache is best relieved by 



2Y8 SPECIAL MEDICAL CASES. 

atropia and sweet almond oil, as suggested in another part of this 
manual. Applications of hot-cloths wrung out of boiling water, 
applied about the throat and covered by thick dry cloths, relieve 
the pain and swelling of the neck or throat. 

Gargles, containing cholrate of potash, or one of the astringent 
preparations of iron, preferably the tincture chloride with glycerine, 
where the child is old enough to use a gargle satisfactorily, is likely 
to do good. The writer prefers an application of nitrate of silver, 
twenty grains to the ounce of water, brushed very gently to the 
inflamed surfaces, once or twice a day. A slice of pork, cut as 
thin as possible, and stitched on muslin or flannel (the pork to 
reach from ear to ear) tied or pinned around the neck, is a valu- 
able application. It is well to sprinkle salt, or powdered camphor, 
upon the pork in order to secure a speedier action. It is always- 
proper to begin treatment by giving a gentle cathartic. Indeed, 
simple, or mild cases of scarlet fever, and without any complication, 
seldom require much treatment ; a simple diaphoretic mixture,, 
like the following, after a cathartic, is all that may be required l 

R 

Sweet Spirits Nitre, three drachms. 

Syrup Ipecac, three drachms. 

Simple Syrup, one ounce. 

Aconite Tincture, three drops. 

Mix. Dose. — One teaspoonful every two hours to a child 
two to five years old. 

Medicines to promote the action of the skin and facilitate the 
elimination of the scarlatinous poison, cannot be too highly recom- 
mended in all cases of scarlatina. Such agents likewise aid in 
lessening the fever and tend to promote the eruption. In the very 
severe or malignant cases of scarlatina, measures which reduce the 
vital powers cannot fail to be injurious. In most of these cases- 
there are evidences of prostration from the start, such as drowsiness, 
great restlessness, delirium, feeble pulse, as shown by the dusky 
or bluish color of the surface. These symptoms call for stimulants. 
In the ordinary as well as severe forms of this disease, carbonate 
of ammonia, given with a tonic, is one of the very best remedies, 



SPECIAL MEDICAL CASES. 279 

and is indeed recommended by the best authorities. It may safely 
be prescribed at the first visit of the physician, and given at proper 
intervals throughout the disease. It is regarded as a main remedy 
by a great many judicious and skilled physicians. The following 
is an eligible formula for this class of remedies: 

B 

Carbonate of Ammonia, one drachm. 

Citrate of Iron and Ammonia, one drachm. 

Simple Syrup, three ounces. 

Mix. — For a child of five years, in doses of a teaspoonful 
every two or three hours. 

The preparations of cinchona are also valuable tonics. 
The following prescription has very salutary effects on the 
throat, aside from the valuable tonic and other properties, viz: 

R 

Tincture Chloride of Iron, two drachms. 

Powdered Chlorate of Potash, two drachms. 

Glycerine, one ounce. 

Simple Syrup, two ounces. 
Mix and order a teaspoonful, every two hours, for a child 
three years old. 

DROPSY FOLLOWING SCARLET FEVER. 

The nephritic affection (the inflammatory condition of the 
kidneys) which is so common a sequel or result of scarlet fever, 
is frequently more dangerous than the scarlet fever itself. 
Anasarca or dropsy is most apt to occur in the second or third 
week after the date of convalescence, that is, during the stages of 
desquamation (scaling or separation of the cuticle). It follows 
mild cases of scarlet fever as well, if not more frequently, than the 
severer forms of the disease. It is an important question whether 
this sequel proceeds exclusively or chiefly from an agency per- 
taining intrinsically to scarlatina, or whether it depends on 
extrinsic causes, such as the action of cold. I have known it to 
occur in cases in which the utmost care had been taken in regard 



280 SPECIAL MEDICAI, CASES. 

to exposure to cold. But it is very probable that exposure is 
a frequent cause of this trouble. It should always be remembered 
that children are especially liable to be readily affected by changes 
of temperature and currents of air, and it is highly important that 
the greatest care in reference to the hygienic management should 
be exercised in this respect in the three or four weeks succeeding 
scarlet fever. A thorough knowledge, too, and clear appreciation, 
on the part of the physician, of the proper therapeutic indications 
is highly necessary, since by judicious treatment many, if not all 
recover, whose lives would inevitably be sacrificed by improper 
measures. As the kidneys are, in these cases, highly congested 
or inflammed, diuretics which stimulate these organs should not 
ordinarily be given, at least not until this swollen condition has, 
in a measure, abated. As the eliminating functions of the skin, 
and of the intestinal mucous surface are, to a considerable extent 
vicarious (acting for the other) with that of the kidneys, diaph- 
oretics and purgative remedies are required. Indeed, nephritis 
calls imperatively for hot-baths, under which all the symptoms of 
this complication, including vomiting, are wont to speedily subside. 
The bath must be hot ( ioo° to i io°F. ) ; the patient immersed full 
length, then rolled in a woolen blanket and covered in bed, and 
be allowed to sweat for an hour. If free sweating is not produced, 
it may be promoted by placing against the patient a number of 
bottles of hot water, surrounded by a wet woolen blanket. The 
steam arising from this produces prompt perspiration. This 
treatment may be repeated each day, if the patient requires it, 
while at the same time diaphoretics or cathartics are given. 

The diaphoretic which is most serviceable in this affection, 
is the acetate of potash. It should be given dissolved in water or 
syrup, in doses of about one grain for each year of the child's age; 
sweet spirits of ether may be combined with it and increases its 
effects very much. The following formula is also a good one for 
this purpose : 
R 

Sweet Spirits of Nitre, one ounce. 

Spiritus Mindereri, four ounces. 

Mix. A teaspoonful for a child of five years every two hours. 



SPECIAL MEDICAL CASES. 281 

The external measures of heat described above materially aid 
these diaphoretics. If perspiration is not produced, the action of 
the medicines is probably on the kidneys, and if diuresis (profuse 
flow of urine) do not result, there is danger that the inflammatory 
condition of these organs may be increased. In such cases these 
medicines should be omitted and cathartic medicines given in 
place, or where there is too much exhaustion, it is sometimes 
better to trust to the local or external measures — hot-baths — 
suggested. In robust children suffering from anasarca or dropsy, 
or even from scarlatinous uraemia, and serous effusions, into the 
chest, abdomen, etc., no medicines afford so much relief as 
cathartics of a hydrogogue (producing watery stools) nature. A 
mixture of jalap and cream of tartar (the compound jalap powder) , 
which can be obtained at any reliable drug store, fully meets the 
indication. In children somewhat reduced, medicines of this nature 
are even often required. In older patients, powdered gamboge may 
be added. Cathartics are more certain in their effects than either 
•diaphoretics or diuretics, and, therefore, they should be given in 
urgent cases in which it is necessary to remove the urea or water 
as speedily as possible. After the use of cathartic or laxative 
agents for four or five days, the kidneys, being then less congested, 
often begin to excrete more urine, when diuretics may be given 
likewise. The laxative should, however, be continued, in doses 
sufficiently large, two or three times a day, to produce watery 
passages, for several weeks. In most cases of this renal trouble, 
there is anaemia, and iron in the form of tincture chloride in small 
doses should not be neglected ; it may, in fact, advantageously be 
given at all times. Uraemia, together with convulsions, sometimes 
suddenly follows scarlet fever, even without an outward appearance 
of dropsy. Whenever a child, during convalescence from this 
disease, complains of violent headache, vomiting, or is seized with 
convulsions, there is cause for the suspicion of uraemic poisoning, 
and the course of treatment here suggested is not only highly 
proper, but constitutes the sheet-anchor of success. 

TYPHOID FEVER AND ITS PREVENTION. 

This fever, which prevails very extensively in this country, 
has been known under various names ; such as common continued 



282 SPECIAL MEDICAL CASES. 

fever, abdominal typhus, enteric fever, autumnal fever , pythogenic 
fever, etc. It is customary to apply the name tj^phoid to a 
condition or state incidental to many diseases, and hence more or 
less confusion arises. But of the numerous names which have 
been proposed, no one has as yet been generally adopted, and the 
disease will probably continue to be called typhoid fever. The 
typical typhoid condition ot typhoid fever, and other diseases, 
exists when the patient is profoundly prostrated ; characterized 
by great muscular feebleness, a tendency to slip down in bed,, 
twitching of the muscles of the fore- arms, sordes on the teeth, dry, 
brown tongue, feeble and rapid pulse, low-muttering delirium, 
with picking at the bed-clothes, and involuntary passage' of feces- 
and urine (perhaps retention of the latter). Typhoid fever has- 
its habitat in the intestines, and is due, according to most writers, 
to the bacillus typhosus, and characterized by inflammatory 
enlargement or ulceration of Peyer's patches and enlargement of 
the mesenteric glands and spleen. It is communicated by the 
stools, which become contagious after stagnation and decomposi- 
tion, the contagion being conveyed through the emanations from 
sewers and through contaminated water, food or milk. The 
period of incubation is from one to four weeks, after which the 
disease sets in, usually insiduously, with malaise, headache and 
back-ache, epistaxis (bleeding from the nose), cough, ilio-caecal 
tenderness, and fever which rises higher and higher each day, 
remitting always in the afternoon. In the beginning of the 
second week the fever reaches its acme, and an eruption appears, 
consisting of lenticular rose-colored papules, which appear on the 
abdomen and flanks in successive crops, each crop persisting for 
two or three days. The ilio-caecal tenderness becomes marked, 
and is accompanied with gurgling ; diarrhoea now sets in, the 
evacuations resembling pea-soup in color and consistence ; there 
is tympanites, and the spleen becomes distinctly enlarged. This 
stage of acme lasts a week or so and is followed by a stage of gradual 
decline of the temperature and other symptoms, and very gradual 
convalescence, which is often interrupted by one or more relapses. 
In the stage of acme the patient frequently passes into the typhoid 
state, (quoted above). Death may occur from exhaustion or from 



SPECIAL MEDICAL CASES. 283" 

the continued high temperature, or from the complications , the 
most important of which are intestinal hemorrhage, intestinal 
perforation with peritonitis (often occurring during convalescence) 
pneumonia, pleurisy and bronchitis. Other complications of 
typhoid fever are : bed-sores, mumps and permanent mental 
disorder. 

TREATMENT. 

Careful nursing, with milk or other unirritating liquid diet. 
Cold baths, antipyretic doses of quinine, phenacetin, antifebrine, 
etc., to reduce abnormal temperature. Vegetable astringents, 
bismuth, opium and sulphuric acid for diarrhoea. Turpentine 
internally for intestinal hemorrhage. Opium in perforation. Pre- 
vention of bed-sores by avoidance of pressure and attention to the 
state of the skin — particularly lotions of alcohol. Stimulants, 
as alcoholics, etc., where signs of prostration develop. 

PROPHYLAXIS, OR THE PREVENTION OF TYPHOID FEVER. 

1 ' Typhoid fever is certainly to a large extent a preventable 
disease." — Pepper. Since it is produced by a specific germ, it is 
self-evident that the paramount object of prevention is to destroy 
the germ wherever known to exist, and at the same time use every 
precaution against its admission into the system. As the faecal 
discharges in each case of this disease contain the virus in great 
abundance, they must be thoroughly disinfected and properly 
disposed of. The disinfected discharges should be emptied into 
privies or water-closets, or buried in the earth at points remote 
from the supply of drinking-water, and never emptied on the 
ground. Like attention to the disinfection of the body-linen of 
the sick, the bed-clothing, the mattresses and to the furniture of 
the sick-room is highly important. 

While thus endeavoring to prevent extention of the disease, 
it is very essential to make careful search for the source of infection 
in each individual case. It is very frequently traceable to defective 
drainage, sewerage, water-supply or milk-supply. During the 



i 



284 SPECIAL MEDICAE CASKS. 

existence of an attack of typhoid fever it is desirable that both the 
water and milk should be boiled before being used. The source 
of this disease has recently been traced to the eating of raw 
oysters. It were well if hygiene were taught more thoroughly in 
our public schools, especially as bearing on infectious diseases. 

TYPHUS FEVER. 

This fever, which has been known from the earliest antiquity, 
has received a great variety of names. As its development is 
favored by overcrowding, bad ventilation, filth and starvation, and 
because of its frequent occurrence in prisons, camps, ships, etc., 
it has been called jail fever, camp fever, ship fever, famine fever, 
etc. The name typhus, introduced by Sauvages in 1759, is now 
generally adopted by writers of all countries. The term is derived 
from the Greek, stuphos, signifying stupor, relating to a feature 
which is usually more or less prominent in this disease. It has 
many features in common with typhoid fever. But the identity 
or non-identity of the two affections has been, heretofore, a mooted 
question. They present points of contrast amply sufficient to show 
that they are distinct diseases. In typhus, the abdominal lesions 
which are so characteristic of typhoid fever, are wanting ; the 
Peyerian and solitary glands are unaffected. The mesenteric 
glands are likewise not infiltrated as in typhoid fever, but are 
generally healthy. The stage of incubation or access is also 
shorter than in typhoid fever, and cases of an abrupt invasion are 
not as rare. The symptoms during the development of these two 
fevers are essentially the same, with this important difference that 
in tpyhus the diarrhoea, flatulency, gurgling, etc., are wanting. 
It is highly contagious, the contagium or virus being contained in 
the breath or exhalations from the skin. In the United States it 
occurs in epidemics. One attack secures immunity from another. 
The invasion is preceded by malaise for a day or two and is ushered 
in by slight chills, headache, muscular pains and weakness, a 
dusky flushing of the skin, accelerated pulse, and rapid elevation 
of temperature, the latter reaching its maximum (103 to 106 ) 
between the third and fifth day. At this level it stays for two or 



SPECIAL MEDICAL CASES. 285 

three days, showing but slight diurnal variation, and then falls 
somewhat until the period of crisis. Meanwhile the other 
symptoms increase, the prostration finally becoming very great, 
the pulse more frequent and feeble, the tongue dry and black, the 
teeth covered with sordes, and the muscles tremulous ; the patient 
passes from a state of active delirium into a state of low muttering 
delirium or into almost complete coma ; the feces are passed 
involuntarily, and there is retention of urine. The breath and 
sweat exhale an offensive, mouse-like odor. The mortality of 
t3'phus fever is from 10 to 15 per cent. , being very slight in children 
and increasing steadily with the age. The mortality does not differ 
with that of typhoid fever, being about the same. 

TREATMENT. 

Thorough ventilation, secured by keeping the patient in a 
large, airy room ; liquid diet, especially milk and animal broths ; 
mild febrifuge and diuretic remedies ; opiates or the bromides for 
delirium ; ammonia and alcoholic stimulants when necessary, 
constitute the main features of treatment. 

EPIDEMIC OR ASIATIC CHOLERA. 

This is an infectious epidemic disease, which has received a 
great variety of names, such as Indian, Oriental, Epidemic, 
Malignant, Asiatic cholera, Pestilental cholera, etc., etc. The 
disease appears to be indigenous (native) in India and to have 
existed there for a long period. In other parts of the world it has 
made visitations solely as an epidemic. In 18 17 it commenced its 
march from Bengal, and during the following fifteen years it travers- 
ed nearly the whole of the known world, It prevailed in different 
parts of this country for the first time in 1832, and again in 1834. 
It began its march a second time in India in 1847, and again 
traversed the greater portion of the globe, prevailing in the United 
States in 1849, 1850, 1851, and 1852. Commencing again its 
march over the globe in 1864, it reached this country in 1866, 
and during that and the following year it prevailed in many of 



2<S6 SPECIAL MEDICAL CASES. 

the large towns in the different states in the Union. The last 
epidemic in this country prevailed in 1873. 

In the great majority of cases the disease is preceded by 
simple diarrhoea, the passages being greater or less in number, 
copious, and painless. This preliminary diarrhoea in different 
cases varies from a few hours to several days, and with this 
diarrhoea in some cases occasional vomiting occurs. If diarrhoea 
has existed, the discharges are suddenly copiously increased, the 
disease being characterized by profuse fluid evacuations, resembling 
rice-water, from the bowels, suppression of urine, cramps and 
profound prostration. 

The contagion of cholera is contained in the evacuations from 
the bowels. These being most virulent after standing from one to 
three days, and is usually conveyed in drinking-water. It consists 
probably of the comma-bacillus , a curved spirrilum found in the 
stools. 

Cholera is a very fatal disease, death occurring from exhaus- 
tion, or with coma and convulsions, or from pulmonary congestion. 
The average mortality in hospitals varies from one-half to one-third. 
But in private practice, especially among the better classes of society, 
the mortality is considerably less. In individual cases the prognosis 
is widely different according to the period of the disease at which 
the patient is first seen. "If seen immediately after the attack, 
before serious blood-lesions have occurred, the prospect of an arrest 
of the disease is good. But if the disease has advanced to the stage 
of collapse, the prognosis is always exceedingly unfavorable." 
— (Flint). 

treatment. 

There are but few articles in the entire materia medica which 
have not at one time or other been tried for the cure of this dread 
disease, many of them highly injurious, but it would be unprofit- 
able to devote space to their enumeration. The remedy on which 
most dependence is to be placed is opium, in tincture or morphine 
(the latter hypodermatically); the same may be given in very 
large doses in this affection. This remedy will be indicated by 



SPECIAL MEDICAL CASES. 287 

the pain, diarrhoea, etc. The premonitory diarrhoea calls for 
astringents, bismuth, chalk, opiates, etc. Regulated diet, rest, 
with perhaps a tonic remedy, for the convalescent. 

PREVENTION OF CHOLERA. 

The prevention of this disease claims considerable attention 
-and we should always give it precedence over the therapeutical 
management, in view of its greater relative importance. Preven- 
tion is always better than cure, and indeed in no respect more so 
than with reference to this disease. In addition to the removal, 
as far as possible, of all the auxiliary causes of disease which 
contribute to render the special cause of cholera efficient, the 
prevention involves prompt attention to the diarrhoea which, in 
the great majority of cases, precedes the attack. This premonitory 
diarrhoea is readily amenable to simple measures of treatment, 
and, if faithfully carried out, cholera would in a great measure be 
preventable. Another mode of escaping the disease is to remove 
without range of its prevalence. All persons not compelled to 
remain by necessity, or by a sense of duty, should go beyond the limits 
of the epidemic. These remarks relate to the prevention of cases 
of cholera during an epidemic. To prevent an epidemic is an object 
of still much greater importance. This is to be done by thorough 
measures in regard to the removal of all filth, attention to sewers, 
cesspools and privies, also to wells or other sources of water-supply , 
together with proper protection against causes of disease from 
waste-pipes in houses ; providing against overcrowding in tene- 
ments, etc. , and by rigid quarantine regulations. Ships, merchan- 
dise, baggage, etc., coming by sea or land from a cholera region, 
should be effectually disinfected. When the introduction of the 
disease is not prevented, the prevention of its diffusion is practicable 
and may be ' ' stamped out ' ' by the prompt and effective disinfection 
of every house in which it occurs. 

DELIRIUM TREMENS OR ALCOHOLISM. 

This affection is due to the prolonged use of alcoholic beverages. 
It is also called mania a potu. The effects of alcoholism enters 



288 SPECIAL MEDICAL CASKS. 

directly into the causation of many affections, such as cirrhosis of 
the liver, fatty liver, gastritis, epilepsy, muscular tremor, pyrosis 
(heart-burn) , and many dyspeptic disorders. The excessive use of 
liquor likewise favors the production of nearly all diseases hy 
lessening the power of resisting their causes, and at the same time 
contributes to their fatality by impairing the ability to bear and 
overcome them. For the intoxicating effects of alcohol, the reader 
is respectfully referred to another chapter of this book. The 
habitual use of liquor produces a deleterious influence on the whole 
economy, it weakens and impairs the appetite, enfeebles the entire 
muscular system, and the generative function is decayed. The 
blood is impoverished, nutrition is imperfect and disordered, as 
shown by flabbiness of the skin and muscles, emaciation, or an 
abnormal accummulation of fat. The deleterious influence on the 
mental is not less marked than on the physical powers. The 
perceptions are blunted, the intellectual and moral faculties 
progressively deteriorate, until, at length, the confirmed drunkard, 
miserably cachectic in body, and imbruted in mind, has but one 
object in life, namely, to gratify the morbid craving for liquor. 

Delirium tremens is an affection incidental to alcoholism, but 
it has been a mooted question whether the affection is due to the 
sudden withdrawal of alcoholic stimulants, or whether it is a direct 
consequence of the prolonged action of alcohol on the brain. 

Symptoms. — The most prominent and distressing symptoms 
attending this affection are hallucinations of sight and hearing — 
the objects perceived being usually of a repulsive character. He 
sees imaginary objects, such as mice, dogs, cats, lice, snakes and 
ferocious animals. He hears noises of animals or men, answers 
imaginary questions, and is apt to fancy the presence of persons 
who are bent on insulting or ridiculing him, or from whom he 
apprehends fearful personal violence, etc., etc. In this terrible 
state of mind patients not infrequently leap from windows and are 
dashed to pieces — believing that they are followed by wild beasts 
or by men who seek their lives. Other symptoms attending the 
outset of this trouble are complete loss of appetite, insomnia, 
muscular tremor, more especially tremulousness of the tongue, and 
notable depression of the mind. This state is known among 



SPECIAL MEDICAL CASES. 280 

drunkards as "the horrors." The insomnia, or wakefulness, is 
indeed the main feature of this dreadful malady. The insomnia 
continues, the sufferer gets no sleep for two, three or four days 
and sometimes for a still longer period after the development of the 
affection. The delirium is always much worse during the night. 
Anorexia (loss of appetite) with constipation of the bowels, 
continues throughout the affection. The prognosis is generally 
favorable. When not associated with other affections, a fatal 
termination is very rare. The affection destroys life per se, chiefly 
in cases in which repeated attacks have occurred, and the consti- 
tution is broken by a long-existing alcoholic cachexia. But 
delirium tremens occurring after wounds, surgical operations, 
accidents, or when associated with other diseases, as for example, 
pneumonia, it adds largely to the gravity of the prognosis. It is 
important to bear in mind that inflammation of the brain is not 
involved in this affection, nor is there ground to believe that 
congestion is an essential element — the nature of the morbid 
condition, as in the other neuroses, is unknown. 

TREATMENT. 

The great object of treatment is to procure sleep. But in the 
medical treatment of delirium tremens the first indication is to 
remove effete materials from the system, and relieve abdominal 
engorgement. With this in view, it is well to give three or four 
grains of ipecacuanha every fifteen minutes until free vomiting is 
produced, even if the patient be suffering from excessive nausea 
and vomiting. After the emetic has acted, three grains of calomel 
should be administered, which is to be followed, several hours 
afterward, by a dose of the compound jalap powder, sufficiently 
large, to produce free purgation. 

To quiet nervous excitement and procure sleep, we must rely 
on the bromides, opium or morphine, chloral hydrate, etc., etc. 
The combination of chloral and sulphate of morphine far exceeds 
in efficiency and general applicability all other hypnotics. The 
chloral (15 to 20 grains and morphine % grain) may be given at 
bed-time, and repeated in half this dose at intervals of an hour, 






2 ( J0 SPECIAL MEDICAL CASES. 

through the night, with care not to overdo the exhibition of 
narcotics. Bromide of potassium, in large doses, thirty to sixty 
grains, repeated ever} T hour or two, in combination with small 
doses of opium, Iryoscy amine or cannabis indica, will frequently 
tranquilize the nervous system and procure sleep readily. The 
opiates are to be administered with circumspection in this affection. 
Tincture of digitalis and strychnine, especially where heart stimu- 
lants are indicated, are valuable agents in this disease. Chloroform, 
by inhalation, has been empkwed in an obstinate case, by the 
writer, with the happiest results. The management in other 
respects is highly important. Visitors, or at least curiosity seekers, 
are to be excluded from the sick-room. The circumstances 
surrounding the sufferer should, as far as possible, be regulated 
with a view of promoting sleep. The patient should be encouraged 
to take plenty of nutritious and easily digested food. 

One of the most important questions to be decided in the 
treatment of this affection, is as to the necessity of using alcoholic 
drinks. In man}^ cases it does harm, and the moral reasons 
against its employment are ver} T strong, but in feeble subjects or 
in old drunkards the exhibition of liquor in some form or other, 
may be necessar}^ to the saving of life. Proper restraint to prevent 
the patient injuring himself or others, must likewise be employed ; 
property constructed straps, securing the patient in bed, are, in a 
violent case, much better than restraint by means of nurses, being 
more steady and certain in its action, and creating less opposition 
on the £art of the patient. It is an important duty of the physician, 
after recovery from this disease, to inform the patient of its 
character, and to point out the inevitable consequences of the 
habits which have induced it. And the poor patient may thus be 
aided in an effort to emancipate himself from the slavery of 
intemperance, by remedies and hygienic measures which tend to 
invigorate the bodj^, thereby strengthening the mental powers. 
The unhapp3 T slaves of intemperance should be considered as 
suffering . from disease, and should be treated as patients until the 
morbid craving is extinguished by prolonged abstinence. 

Shakespeare probably had one of these unfortunate persons 
in mind when he wrote, "O, thou invisible spirit of wine, if thou 
hast no name to be called b} r , let me call thee devil !" 



SPECIAL MEDICAL CASES. 1591 

ERYSIPELAS AND TREATMENT. 

Erysipelas may be defined as an acute, specific and contagious 
fever, tending usually to a typhoid type, and characterized locally 
by a peculiar inflammation of the skin or mucous membranes. It 
may attack the same person more than once. The disease is 
known by a variety of names, such as the rose, St. Anthony's 
fire, etc. It is caused by a specific microbe known as the 
Streptococus erysipelosus, and has been known from the earliest 
period of medical history. En r sipelas is divided clinically into 
two forms: i. Idiopathic (self- originated) , or "medical" 
erysipelas, involving chiefly the face and head ; 2. Traumatic 
(produced by injur}') , originating at the site of a wound anywhere 
upon the surface of the body. Age, season of the year, climate 
and sex do not especially influence the susceptibilit}^ to the disease, 
but occurring in the puerperal state, and in small children, it is 
especially virulent and dangerous. The disease is greatly favored 
by bad hygienic surroundings, filth and overcrowding. 

There is abundant proof that erysipelas is communicable by 
contagion, and it is highly important that physicians or surgeons, 
in attendance upon cases of this kind, observe the greatest possible 
care in attending cases of confinement, as the disease may thus be 
conveyed to those in the puerperal state — and perhaps generate 
puerperal fever. 

TREATMENT. 

There is no specific remedy for erysipelas — abortive remedies, 
either local or constitutional, fail completely in the majority of 
cases, thereb}^ illustrating the general truth or fact in therapeutics 
that modes of treatment, and especially of acute febrile affections, 
should be determined by their type, rather than by their essential 
nature. 

In many instances it is so far local and superficial or mild 
that its treatment may be confided to protectives and palliatives, 
but in the severer forms of the disease, from whatever cause or 
variety, calls for a general or constitutional treatment at once 



292 SPECIAL MEDICAL CASES. 

stimulant, supporting and tonic as the only one from which favorable 
results can be expected. An ordinary case of this affection 
should be treated about as follows : The inflamed part should be 
placed in as comfortable a position as possible, and the face, when 
affected, should not be exposed to a strong light ; the skin should 
be dusted with lycopodium, or finely powdered starch, or wheat 
or rye flour, and covered with carded cotton ; 'and in cases 
attended with much burning and tension, a smaller or larger 
proportion of oxide of zinc should be mixed with the flour, or the 
part may be kept anointed with vasaline. Vasaline is greatly 
superior to ointments, for, unlike them, it is not apt to become 
rancid. It may also serve as an excipient for oxide of zinc or 
lead, or extract of opium which ma}^ seem appropriate. 

Sweet oil, with twenty per cent, of carbolic acid, is likewise 
an excellent local application. The compound solution, or the 
compound tincture of iodine, painted on the inflamed parts, are 
valuable applications to relieve the pain and swelling in some 
cases. 

The internal medication of erysipelas may very appropriately 
commence with a purgative, like the epsom salts, or jalap and 
cream of tartar, which will tend to allay the temperature, mitigate 
its severity and modify its course, partly by cleansing the alimen- 
tary canal, and partly by quickening all the eliminating secretions, 
and very possibly by expelling in this manner a portion of the 
morbid poison contained in the blood. In all classes, tincture iron 
chloride in large doses, 20 to 30 drops, for adults, largely diluted, 
every few hours, is highly beneficial. Pilocarpine, belladonna 
and quinine, especially the latter, when a tonic is indicated, or 
blood-poisoning feared, are all remedies highly lauded in the 
affection. 

SCABIES OR "ITCH." 

Scabies, also called " the itch," is a contagious inflammatory 
disease of the skin, having its origin in an animal parasite. It is, 
as its name indicates, an essentially pruritic disease, and its 
intensity is increased and its continuance largely established by 



SPECIAL MEDICAL CASES. 293 

the wounding of the skin incident to the scratching which its 
itching causes. It is chiefly a disease peculiar to the poor, 
uncleanly and filthy people, but it is not uncommon to find it in 
the middle, hard-working, and reasonably clean classes, and it is 
sometimes found in persons of the higher walks of life whose 
personal cleanliness is beyond question. While the affection can 
only orignate through this parasite, known as the itch-mite, 
(Acarus Scabiei), it should however be remembered that eruptions 
almost, if not wholly identical, are produced by other varieties of 
the sarcoples, derived from horses, dogs, cats, camels, sheep and 
rabbits. It is well therefore in trying to make out the diagnosis, or 
nature of a case, not to be satisfied by simply inquiring as to 
whether the patient has come in contact with a person so affected, 
or handled an animal, or been in contact with it in any way. The 
affection is readily curable ; recent or mild cases may be cured in 
a week or ten days ; more advanced or extensive eruptions require 
a somewhat longer time. 



TREATMENT. 

The indications for treatment, which is purely external, are 
to destroy the itch-mites, to cure the inflammatory changes which 
they may have caused, and to use ample caution that the treatment 
adopted does not produce irritation or be too strong. It must be 
borne in mind that infants, children and women, as also some men, 
cannot be treated as heroically, as individuals with a coarse and 
resistant skin. The best method of procedure in cases of itch, is 
as follows : Rubbing of the whole body and particularly of the 
parts most affected, with a thick lather of soft soap, or some other 
good grade of soap, for twenty minutes. By this means the mites 
are dislodged from the surface of the skin, the hole or burrow is 
rendered accessible to the parasiticide applications, and the ova or 
eggs may be killed. The second stage of treatment consists of a 
bath or thorough washing of the entire body with warm water. 
The third stage begins with the inunction into all parts of the 
l>ody the following ointments, daily, for about a week. 



294 SPECIAL MEDICAL CASES. 

R 

Flower of Sulphur, two drachms. 

Subcarbonate of Potash, one drachm. 

L,ard, two ounces. 

This may be used in severe cases where the skin is not fine 
and delicate. The following is a finer ointment : 

R 

Flower of Sulphur, three drachms. 

Naphthol, three drachms. 

Balsam Peru, three drachms. 

Vaseline, four ounces. 

Creasote, twenty drops. 

PEDICULOSIS OR LICE. 

A number of animal parasites or epizoa affect the human 
skin, among these are three varieties of lice. The pediculosis 
capitis or lice of the head, the treatment of which varies in its 
simplicity according to the severity of the case. If their existence 
is made out before much dermal irritation has been produced, their 
destruction is readily accomplished by saturating the scalp with 
tincture of larkspur, or w T ith the following lotions : 

R 

Bichloride of Mercury, one to two grains. 

Cologne water, three drachms. 

Water, four ounces. 

or 

B 

Carbolic Acid, two drachms. 

Glycerine, one ounce. 

Water, eight ounces. 

These lotions should be well rubbed into the roots of the 

hairs and along their entire length, and thus the pediculi and. 

ova are both destroyed. After these preparations have been oni 

the scalp for several hours, the head should be shampooed with 

soap and water, when a fine-tooth comb should be used, which is 

a valuable adjunct to the treatment. A cure is more easily effected 

if the hair are cut. The following is also a sure remedy : 



SPECIAL MEDICAL CASES. 295 

B 

Xaphthol, two drachms. 

Vasaline, one ounce. 

PEDICULOSIS PUBIS OR " CRAB LICE." 

This parasite is called the "crab louse" (pcduulus pubis). 
It is a very common affection, and is seen in the better classes of 
people, male and female, as well as in the lowest of them. It is 
most commonly observed in adults, and is usually conveyed in 
sexual contact. While its habitat or principal place of abode is 
in most cases upon the pubis and lower portion of the belly, the 
insects are often found upon the chest, in the armpits, upon and 
among the eyelashes and eyelids, in the beard and even upon the 
head. The}' are likewise not infrequently found, especially in 
hairy men, on the thighs and even on the legs. In some of these 
cases the lice reach these distant parts by migration, in others by 
transference by means of the fingers and nails. 

TREATMENT. 

Mercurial ointment is a remedy in high repute among the 
laity, high and low, and indeed well deserves its fame for the 
destruction of these parasites, but it is apt to cause congestion of 
the parts to which it is applied, and even so severe eczema, that 
its use should be restricted to cases of emergency. 

The following lotion or wash is very efficient and pleasant, 
and when carefully, even though quite freely, used, productive of 
no bad results : 

R 
Bichloride of Mercury, four grains. 

Cologne Water, two drachms. 

Water, four ounces. 

Mix and apply twice a day. 

I would recommend the following lotion as also beneficial and 
well suited in cases of females : 



296 SPECIAL MEDICAL CASES. 

R 

Carbolic Acid, two drachms. 

Spirits of Camphor, one-half ounce. 

Glycerine, six drachms. 

Water, enough to make eight ounces. 

Mix. 

It is sometimes necessary to clip the hair close to the skin of 
persons thus affected. 

PEDICULOSIS CORPORIS OR ' ' BODY DICE. ' ' 

This affection is caused by a parasite resembling the lice 
infesting the body, which enscones or shelters itself in the coarse 
meshes of the underclothing and in the seams thereof. It is 
occasionally seen meandering over the integument, but when thus 
sought for is rarely found. The ravages of this insect, and the 
consequent suffering, are caused by the insertion of its proboscis 
into a follicle from which it draws blood for its sustenance. 
Following this bite a minute quantity of blood escapes, which dries 
and forms a little crust at the punctured point, etc. 

TREATMENT. 

• The first essential in treatment is to thoroughly sterilize the 
clothes of the patient and all his bed-linen. To this end, these 
fabrics must be boiled, baked or ironed, at a temperature high 
enough to destroy the lice and not to ruin the clothes. A mild 
carbolic acid lotion, or vinegar and water, may with benefit be 
rubbed on the skin. 

DIPHTHERIA — ITS CAUSE AND TREATMENT WITH ANTI-TOXINE. 

This is a constitutional, febrile, highly infectious or contagious 
disease, characterized by the formation of yellow patches of 
exudation and infiltration upon and in the substance of various 
mucous membranes and the tissues lining raw surfaces. It is 
attended with enlargement of the associated lymphatic glands. 
It affects chiefly the mucous membranes of the pharynx, larynx 
and tonsils, but also attacks the nose, eyelids, vulva, etc. 



SPECIAL MEDICAL CASES. 297 

Diphtheria is caused by a bacillus, which was first discovered 
by Klebs in 1883 and b} T Loefner in 1884. From the fact that 
both observers deserve credit for the discovery of the germ, it is 
often Called the ' ' Klebs-Loefner bacillus. ' ' There are some 
physicians who call every throat affection diphtheria, and in this 
way build up a great reputation and amass lucre. But the writer 
is nevertheless fully cognizant that the diagnosis of this disease is 
not always easily made out, and would herewith quote on the 
subject from the reports to the New York city health department 
on the use of bacteriological examinations for the diagnosis of 
diphtheria by Herman M. Biggs, M. D., the learned pathologist, 
etc., health officer of New York city, as follows : 

" It is admitted by all clinicians of experience in this disease 
that it is often impossible, either from the clinical history or the 
anatomical lesions, or both, to make an accurate diagnosis of 
diphtheria. There are no constant differences which separate the 
simple non-contagious forms of inflammation from the diphtheritic 
and communicable types, and it is only in a rather small proportion 
of cases that an early and reliable diagnosis can be arrived at from 
any data obtainable. The records of the health department of New 
York city have shown this in a very striking w T ay. In the cases 
of suspected diphtheria under treatment at the Willard Parker 
Hospital, in which the diagnosis were made by the department 
inspector and confirmed by the department diagnosticians before 
the removal of the patients to the hospital, subsequent bacteriolog- 
ical examinations showed that from thirty to fifty per cent, of these 
cases were not diphtheria, but were cases of pseudo-diphtheria, 
(false-diphtheria) . ' ' 

The causative relation of the Klebs- Iyoeffler bacillus to 
diphtheria is no longer doubted or disputed by bacteriologists, and 
its great virulence is fully demonstrated, as the same has been 
retained after a series of twenty inoculations of the false membranes 
upon so many rabbits. 

The human blood can be predisposed to, or against disease, 
as by vaccination against small-pox, by the Pasteur method agairfst 
hydrophobia, and as is now being demonstrated, by the inoculation 
of anti-toxine or the new diphtheria serum, against the much 
dreaded scourge — diphtheria. 



298 SPECIAE MEDICAL CASES. 

Numbers of healthy persons have been found to have 
diphtheria bacteria in their blood ; their blood had acquired a 
quality which proved an antidote to the bacilli. History and 
experience tells us that the most dreaded of all enemies of man 
are the infectious diseases. But there is one consoling feature of 
these so much dreaded diseases, that is the immunity granted or 
afforded by one attack against subsequent invasions. The general 
reader will know this fact, in at least as far as small-pox, scarlet 
fever, measles, mumps, etc., are concerned — persons as a rule 
taking these affections but once. 

However benign the disease or mild the epidemic, it leaves 
some mark of devastation in its path — it is precisely this condition 
which the injection of anti-diphtherine produces in an artificial 
manner, if done at the proper time, the serum or transparent 
portion of blood of horses or other animals, previously rendered 
immune by graded inoculations, being empkyed for the purpose. 

The anti-toxine is prepared in the following way, viz ; A 
horse > a healthy animal, being chosen, is inoculated with the 
deadly Klebs-IyOefHer bacillus. The more violent, the better the 
results will be. The extremely poisonous cultures having been 
prepared and its strength fully determined, is injected into the 
animal which is to furnish the serum, beginning with very small 
doses, which are gradually increased, until the most powerful 
poison can be resisted by the animal. Many months are required 
to obtain such immunity, and the constant liability to the loss of 
animals from an overdose of the toxine is very great. Other 
animals than the horse may be utilized for the purpose, as the 
cow, sheep, goat, dog or guinea pig, but the horse is preferably 
selected as possessing more susceptibility. 

As soon as the horse or animal chosen has developed a high 
degree of immunity, it is ready to furnish anti-toxine. The blood 
is obtained from the larger veins in the body, the animal having just 
been put under the influence of morphine or an anaesthetic. The 
serum is then separated from the blood and in this serum is 
contained the anti-toxine. Our learned scientists are constantly 
working to still further isolate this anti-toxine in property and to 
obtain it in a more concentrated form. It may be mentioned that 



SPECIAL MEDICAL CASES. 299 

the strength of the test poison is first thoroughly tested by its 
action upon guinea pigs, through a tedious process of inoculations, 
before it is used on human beings. 

But however careful this process of attenuation has been carried 
out, although confident the experimenter may be, that the virulence 
of the bacilli has been reduced to a minimum, there always must 
be some danger attending the inoculation of a human being with 
a medium containing the poison of perhaps the most fatal disease 
known, and it ma}' be a long while before the method becomes 
very popular in the treatment of this direful fiend. 

SMALL-POX OR VARIOLA. 

This is a highly infectious and contagious disease, which 
after a period of incubation of about twelve days, is ushered in by 
a high chill, or in some cases by a series of chills, followed by 
high fever, the thermometer sometimes showing 104 to 106 
elevation of the bodily temperature. Nausea and vomiting are 
often prominent symptoms in this stage, with coated tongue. Pain 
in the " pit of the stomach " and limbs are seldom wanting, while 
intense headache and severe pain in the back are always very 
marked symptoms in the early stage of the disease. Convulsions 
often attend the development of small-pox in children, and may 
indeed occur in adults. The duration of this stage, as a rule, is 
about three days — the symptoms reaching their maximum on the 
third day, when the eruption begins to appear in minute hemi- 
spherical, shot-like, reddish papules ; first on the face, neck and 
wrists, and in two days spread over the rest of the body, including 
the mucous membranes. These papules enlarge in two or three 
days, are converted into vesicles, which become navel-shaped, 
increase in size, and about the eighth day are changed into pustules, 
w r hich increase in size for several days and may either run together 
and constitute the confluent form of small-pox, or remain separate 
when they are known as the discrete form of the • disease. The 
general symptoms decline suddenly with the formation of the 
eruption, but as soon as the pustules are developed there is a 
sudden increase of the fever, with chills, which is known as the 



300 SPECIAL MEDICAL CASES. 

"secondary fever." When maturation is complete (this being 
about the eleventh day of the disease) , the secondary fever abates 
and the pustules begin to dry up with the formation of scabs, the 
skin at the same time exhaling a very fetid odor. The scabs fall 
off leaving pitted cicatrices. The confluent form is very fatal. 

Causation. — Small-pox is a highly contagious disease, and is 
readily conveyed from person to person. It is readily transported 
by means of clothing, or anything which may retain the contagium 
in an effective condition for months and even years. A very 
transient and slight exposure often suffices for the production of 
the disease. Thus, it is very frequently taken by passing in the 
street or meeting in public conveyances persons who either are, or 
have been, recently affected with it. The disease may easily 
be communicated from the dead body by means of emanations. 

The susceptibility to the disease exists in all ages, but children 
are most liable to contract it. Some persons are wholly insuscepti- 
ble to it, exposing themselves as fully as possible, without getting 
it. But cases have been observed in which persons have contracted 
the disease who were for a long time insusceptible to it. The 
negro and Indian are particularly liable to get the disease. 

As a rule people have the disease once only, but instances are 
quite frequent where it has occurred twice, and sometimes thrice, 
in the same person. 

varioloid. 

This is a form of small-pox which is distinguished by its mild 
symptoms and by the. drying up of the pustules before they are 
fully formed. 

TREATMENT. 

There is no special treatment for small-pox. The general 
treatment involves the same principles as in the other fevers. All 
the hygienic conditions which are so important in the treatment 
of typhoid and other fevers, are not less important here. Venti- 
lation as free as possible is of especial importance, together with 



SPECIAL MEDICAL CASES. 301 

isolation of the patients. Vaccination of the sick and well is 
imperative as a preventive. Measures addressed to the symptoms 
presented and complications. 

To prevent pitting, many agents have been recommended, 
such as evacuation of the vesicles by means of a fine needle, nitrate 
of silver and tincture of iodine applications, etc. But the best 
agent for the purpose is carbolized oil or other fat over the sur- 
face, sprinkled with sub-nitrate of bismuth or prepared chalk. 
The treatment of varioloid does not claim separate consideration. 
The same principles are involved as in the treatment of ordinary 
small-pox. The comparative mildness, in the great majority of 
cases, renders active treatment unnecessary. Usually little is 
required beyond hygienic measures. 



CHICKEN-POX. 

Chicken-pox, or varicella, as is well known, in some respects 
resembles variola, or small-pox. A failure to discriminate between 
the two may subject the patient to the contaminating atmosphere 
of a small-pox hospital, or, on the other hand, endanger the health 
and lives of many of his neighbors. It is, in fact, solely for the 
purpose of deciding this important point that the physician is 
usually called to see cases of varicella. 

So common are epidemics of chicken-pox — as a rule, one and 
sometimes two such epidemics occur each year — that it is rare for 
any one to reach adult life without having contracted it. Those 
who have never had it must enjoy some peculiar immunity, since 
it is probable that every adult has many times been exposed to its 
contagion. 

In the city of Leipsic an epidemic of chicken-pox has been 
noted to occur regularly after the opening of the infant schools. 

Notwithstanding the frequency of chicken-pox, and the usual 
mildness of its course, it should not be dismissed as of no import- 
ance. The child should be directed to stay in the house while the 
eruption lasts, and during the time in which there is fever he should 
remain in bed. 



302 SPECIAL MEDICAL CASES. 

An eminent writer on the subject recently emphasized the fact 
that the disease ma}^ leave a tendenc} 7 to enlargement of the 
lymphatic glands of the neck, which may then become the focus 
of tubercular infection. Cases of a severe type should subsequently 
be treated with appropriate tonics. 

Pallor, which sometimes follows the disease, should receive a 
physician's care. The eruptions on the face should be looked 
after in a careful way in order that scars may not result. 

After all cases an abundant supply of nourishing food and 
pure air should be provided, in order that no physical weakness 
may continue as a sequel to the disorder. 



CHAPTER XXII. 

Miscellaneous. 

Insomnia, Its Cause and Treatment — Fear As a Factor of Disease and Death — The Blood ) 
the Quantity in a Human Being — The Corpuscles and Circulation — The Function of the 
Blood— Vital Temperature and the Use of the Fever Thermometer — Local and Atmos- 
pheric Temperature— Baldness and How to Take Care of the Hair— Many Valuable 
Hair-Tonics— How to Darken the Hair— Foul Breath and How Remedied — Sper- 
matorrhoea — Its Causes and Consequences— Why Parents and Others, Should Guard the 
Children in Their Charge Against Evil Habits— Sexual Excesses and What They Entail- 
How to Make All Kinds of Poultices— Abortion— The Awful Crime and Endangerment 
to Life of Criminal Abortion— Doctor Cathell's Emphatic Denunciation on the Sub- 
ject—The Best Anti-fat Remedy — How to Cure Sweating Feet and Correct Foul Odor — 
The Way to Remove Freckles— Many Invaluable Health Notes. 

INSOMNIA, ITS CAUSES AND TREATMENT. 

The cry for rest has always been louder than the cry for food. 

Not that it is more important, but it is often more difficult to 

obtain. The best rest comes from sound sleep. Of two men or 

* women, otherwise equal, the one who sleeps the better will be the 

more moral, healthy and efficient. 

Sleep will do much to cure irritability of temper, peevishness 
and uneasiness. It will restore to vigor an overworked brain. It 
will build up and make strong a weary body. It will cure a head- 
ache. Indeed, I might make a long list of nervous and other 
maladies that sleep will cure. 

The cure of sleeplessness requires a clean, good bed, sufficient 
exercise to produce weariness, pleasant occupation, good air, not 
too warm a room, a clear conscience, and avoidance of stimulants 
and narcotics. For those who are overworked, haggard and 
nervous, who pass sleepless nights, I recommend the adoption of 
such habits as will secure sleep. Otherwise life will be short, and 
what there is of it, sadly imperfect and unsatisfactory. 



304 MISCELLANEOUS. 

I really can not conceive of any person so unhappy as one 
who is the victim of this very distressing and troublesome com- 
plaint — sleeplessness. Loss of sleep may bring on brooding over 
imaginary ills ; the person may grow despondent, irritable, mor- 
bid, and sometimes, indeed, it may lead to insanit3 r . 

The causes of insomnia are numerous and varied ; but it is 
not my intention to describe them here, as I shall only treat of 
such cases, and their remedies, as may likely chance to come under 
the observation and treatment of the laity, leaving those of an 
organic source to be treated by the profession. 

A full meal of oysters, in any form, before going to bed, is 
known to work satisfactorily in some instances. In children, and 
adults also, wakefulness may often be overcome, and quiet sleep 
insured, by a tepid bath taken just before retiring. Where over- 
work of the brain, fatigue or mental worry is the cause, the 
bromides of potassium, sodium, ammonium, lithium, etc., are 
specifics, and their hypnotic action is very happy indeed. Gal- 
vanization, as the application of the galvanic battery is termed, 
has been known to afford great relief in some cases. 

When wakefulness is due to a condition of cerebral anaemia, 
a full dose of some alcoholic stimulant, whisky or brandy (a 
moderate drink, immediately before retiring and only then) will 
produce sound and refreshing sleep. In some subjects a glass of 
ale, porter, or beer answers better. Opium or its alkaloid, mor- 
phine (the latter hypodermatically injected) will always rank as 
the best sleep producers, especially where pain exists. As a 
hypnotic, pure and simple, f^drate of chloral is quite unrivaled. 
Cases of sleeplessness due to mental overwork, anxiety, or physical 
fatigue, are entirely relieved by fifteen to twenty grains of chloral. 

The refreshing sleep thus obtained not infrequently leads to 
repeated and long-continued use of the drug, and thus a habit 
may be formed which should always be interdicted. Hence I 
recommend that first proper hygienic and dietetic methods be 
employed, and after all such fail, hypnotics may be used, but only 
as a last resort. Where sleeplessness is superinduced by indigestion , 
habitual constipation, or dyspeptic ailments in general, attention 
should be given to those disorders. 



MISCELLANEOUS. 305 

FEAR AS A FACTOR OF DISEASE AND DEATH. 

The influences of mental emotion on the animal economy has 
never received the consideration its importance demands. Accus- 
tomed to regard the mind as something apart from the rest of the 
human mechanism, we are apt to overlook it when investigating 
questions of animal pathology ; and we constantly underrate its 
power over the processes of growth and decay going on within us. 

For illustration, the writer desires to cite a few instances of 
the effects of mental emotion in totally changed healthy conditions, 
replacing them by serious and even fatal disorders. 

A criminal who had been condemned to death for murder, 
was given into the hand of a celebrated French surgeon. He was 
told that his judges had decided that he should be bled to death 
on a certain hour the following day. When the appointed time 
arrived he was blindfolded and placed in bed. The surgeon 
then made a small incision through the skin, which did not involve 
any of the blood-vessels. One of the persons interested in the 
experiment placed his finger on the pulse, another held a vessel 
of luke-warm water above the wounded arm and allowed the 
liquid to trickle over its surface and drop on the floor. Meanwhile 
the doctor, in his conversation with the assistant, alluded to the 
gradual weakening of the pulse, the fluttering of the heart, the 
paleness of the countenance and the ebbing away of life, until the 
criminal, fully convinced that his end was near, fainted and died, 
without having lost a single drop of vital fluid. 

A similar incident occurred in St. Petersburg less than a year 
ago. A criminal, who had been condemned to suffer the death 
penalty, was told that he was to sleep in a bed from which the 
dead body of a cholera patient had just been removed. He was 
then conducted to a well-ventilated room and placed in a bed 
perfectly clean, which had never been used. Toward morning he 
was taken with all the symptoms of cholera, and died in a few 
hours. 

Fear and worry favor the acquisition of diseases like cholera, 
yellow fever, etc. , etc. Terror has changed the color of the hair 
from black to white. Fear may excite the sweat glands to such 



306 MISCELLANEOUS. 

an extent as to bathe the skin in a profuse perspiration. The same 
emotion may so excite the action of the heart as to make its 
impulses perceptible through the clothing. A single thought will 
often take away the appetite, or the remembrance of some favorite 
article of diet will create one and cause the saliva to secrete in 
abundance. Excitement and worry ma}^ cause convulsions, 
dizziness, intense headache and dimness of vision, together with 
diarrhoea and incontinence of urine. The same causes frequently 
lead to indigestion, and over-indulgence of the mental faculties is 
a very frequent source of d}^spepsia. 

THE BLOOD — THE QUANTITY IN A HUMAN BEING. 

The determination of the entire quantity of blood contained 
in the body has long engaged the attention of physiologists, 
without, however, any absolute definite results. Chiefly because 
the blood is not all discharged from the body after division of the 
largest vessels, as after decapitation. The proportion of blood to 
the bod}^ is, however, stated at about one to ten, and is less in the 
infant than in the adult and is diminished in old age. 

THE CORPUSCLES AND CIRCULATION. 

Where blood is drawn from the body and allowed to stand, it 
solidifies in the course of a few minutes into a jelly-like mass, 
which then separates into two parts, a "clot" or "coagulum," 
and a yellowish fluid, the serum, in which the clot floats. This 
clot consists of a solid, colorless material, called fibrin, and a large 
number of minute cells or corpuscles, called blood corpuscles, 
which are entangled and enclosed in the fibrin. 

These corpuscles are of two kinds. The one kind greatly 
preponderating over the other, in point of numbers, is termed the 
colored or red corpuscles ; the other, fewer in number and less 
conspicious, is termed the colorless or white corpuscles. The 
number of red corpuscles in the blood is enormous. Between 
4,000,000 and 5,000,000 are contained in a cubic millimeter. The 
white corpuscles are very much less in number, and there is onfy 



MISCELLANEOUS. 307 

one for 600 to 1200 red ones. The size of a red corpuscle is about 
one thirty- five hundredth of an inch in diameter and one twelve- 
thousandth of an inch in thickness. 

The white corpuscles are rather larger than the red, measuring 
from about one twenty-hundredth to one twenty-five-hundredth 
of an inch in diameter. Human blood is also composed of water, 
albumen, fibrin, an animal coloring substance, a little fatty matter 
and different salts, as chlorides of potassium and sodium, phosphate 
of lime, subcarbonate of soda, etc. Harvey discovered the circu- 
lation in the year A. D. 16 16, and in 1628 published his v/orks on 
the same. 

There are also besides the red and white, a third variety of 
blood corpuscles, called blood-plaques, which are still smaller than 
the red, being from one-third to one-fifth their size, globular in 
shape, gray in color, and existing in proportion of one to eighteen 
or twenty of the red. Their use is unknown. 

THE FUNCTION OF THE BLOOD. 

The office of the blood is to convey nutrition to all parts of 
the body, and to remove its waste material. The blood has still 
an other function, that of keeping the body warm. Animal heat 
is generated by continual chemical change, in which the blood is 
an active agent. The bodily temperature in health remains nearly 
the same, about 98 ° F., in spite of the variations of the external 
temperature. The action of the skin keeps the heat from 
accumulating, and the arteries, under the influence of the nervous 
system, dilate or contract, and so assist in maintaining the equili- 
brium by altering the rate of production to correspond w r ith the 
loss of heat. L,ife is secure so long as the production and the 
escape of heat are evenly balanced. 

VITAL TEMPERATURE. 

There is a definite daily variation of temperature amounting 
to one or two degrees. The temperature of a health}' adult 
reaches its highest point between 5 and 8 P. M., and its krwest 



308 MISCELLANEOUS. 

from 2 to 6 A. M. A deviation of more than one degree from 
normal, that is above 99 , or below 97 °, may be regarded as 
indicative of disease. There is a range of temperature of about 
20 degrees only in which life can be sustained. A temperature 
of 108 or below 93 , will usually prove fatal. The danger is in 
proportion to the distance from the normal, and to the length of 
time that the condition continues. Temperature below normal is far 
more dangerous than the same number of degrees above. Very 
high temperature sometimes occurs in hysteria without danger. 
Rise of temperature above 99 ° constitutes fever. 

USE OF THE FEVER THERMOMETER. 

A change of temperature may be the first symptom of dis- 
order, occurring even before indisposition is felt. It is of import- 
ance to get this first variation from the normal temperature, and 
as medical advice is not likely to be called for until more evident 
symptoms have manifested themselves, every family ought to own 
a clinical thermometer and to know how to use and read it. One 
can do no harm, but may do a great deal of good, by using it 
upon the first suspicion of departure from health. 

Any great modification of temperature is usually recognizable 
to the touch, but to measure its extent w T ith mathematical certainty 
the clinical thermometer must be used. Before use the index 
must be thrown down to a point two or three degrees below the 
normal. Hold it with the bulb down, and shake until the mercury 
falls, but do not shake it so hard as to force all the mercury into 
the bulb. The temperature may be taken under the tongue, in 
the axilla, groin, rectum, or vagina. A little time may be saved 
by slightly warming the bulb in the hand before its introduction. 
Where great accurracy is needed, the thermometer should be left 
in place until the index has remained station ary for at least five 
minutes. 

LOCAL TEMPERATURE. 

When the temperature is to be taken by mouth the bulb of 
the thermometer is placed under the tongue and the lips must be 



MISCELLANEOUS. 309 

kept closed during the process. Do not take the temperature in 
the mouth immediately after one has been eating ice, nor wash the 
thermometer in warm water before looking at it, as you will get 
alarming results. 

The rectum gives, perhaps, the most reliable temperature, as 
there are but few possible sources of error. For infants this 
method is the best to emplo}\ The tube should be oiled and 
inserted for nearly two inches. Be sure that the tube comes 
directly in contract with the mucous membrane, for if the rectum 
contains faecal matter, the index will reach a point lower than it 
should be. Keep the patient well covered for some little time 
before taking a temperature in the axilla, or armpit. The armpit 
"being first dried, care must be taken that the thermometer is held 
firmly in position. This is best done by pressing the arm closely 
to the side, upward to touch the opposite shoulder. 

Some of the medicines given for fevers, may bring the tempera- 
ture down in two or three hours from a high, to a subnormal 
point, especially in children, who are very susceptible to the 
influence of drugs. 

The pulse and the temperature should always be considered 
together, not separately. The pulse is a more certain test of the 
patient's condition than the temperature. There are three kinds 
of thermometers ; that of Fahrenheit, that of Reaumur, and that 
of Celsius or the Centigrade. Fahrenheit's is the standard used 
in this country. According to Fahrenheit's scale, water boils at 
2i2° and freezes at 32 °. The means employed to reduce the 
bodily temperature are by sponging the entire body with tepid or 
cold water, which may advantageously be acidulated by the ad" 
dition of a little vinegar or alkaliniated with bicarbonate of soda. 
Physicians now very successfully employ a class of medicines 
called antipyretics (opposed to fever) to lower the temperature. 
The chief among these are autipyrine, antifebrin, phenacetine, 
acetanilid and antikamnia. Sulphate of quinine also has these 
properties, given in large doses. All of these remedies should be 
administered with the greatest care and always by advice of a 
physician. 



310 MISCELLANEOUS. 

ATMOSPHERIC TEMPERATURE. 

The human body can bear a high degree of heat diffused in 
the atmosphere. There are eases on record where air of 400 ° 
Fahr. has been breathed with impunity for a short time. It is also 
a fact that the human bod}^ can withstand very severe cold. 
Explorers of the Arctic regions and the extreme northern part of 
Siberia, have reported the thermometer as low as 90 and more 
below zero. The greatest natural cold known is estimated at 105 
below zero, the highest natural temperature is in Egypt, 117 
degrees. Apropos of temperature, I deem is not amiss, for the 
sake of general information, to state that water simmers at 178°* 
Fahr., and boils at 212 Fahr., and no° is the temperature at 
which tea, coffee or other liquids are often drunk. Water freezes* 
at 32 ° Fahr. 

BALDNESS AND HOW TO TAKE CARE OF THE HAIR. 

Baldness or falling of the hair (the technical term of which is 
"alopecia," being from the Greek alopet, a fox, because this 
animal was supposed to be particularly affected with bald patches) , 
is a very frequent affection and generally distinctly a constitutional 
ailment. One should watch for the first symptoms of baldness and 
endeavor to check it by judicious means. 

The treatment of all kinds of loss of the hair should consist in. 
stimulation of the scalp by friction with a good hair brush and by 
shampooing with alkaline, oily and fatty lotions, and in invigora- 
tion of the hair. Where dyspepsia, with headache, is the prevailing: 
cause, that must be removed. If habitual constipation be the 
trouble, proper means must be adopted for bringing the alimentary 
canal into good working order. Fruit should form a part of the 
diet winter and summer. The cold bath should not be neglected,, 
with now and then a course of tonics. Especially if debility be 
present, the vegetable tonics or the syrup of the hypophosphites 
and cod liver oil will do much good. 

In the debility of young men, associated with nervousness,, 
where the baldness occurs in sharply outlined smooth white 



MISCELLANEOUS. 311 

patches, moderate doses of the bromides may advantageously be 
taken three times a day for a month, in conjunction with iron or 
the syrup. Sea air and sea bathing do good if the person's means 
allow them. The bed room and living rooms generally should be 
extra well ventilated. The mattress should be a hard one and no 
more clothing worn by day or night than is absolutely necessary. 
The scalp must be kept very clean. Washing the hair once a 
fortnight, using yolk of egg instead of soap, or a saturated solution 
of boracic acid, and not drying too roughly, will be most 
advantageous. 

Afterwards a simple pomade may be used sparingly. A good 
hair brush should be used daily to thoroughly stimulate the scalp. 
The following is a very good application, to be used night and 
morning : Take of tincture of cantharides two ounces, distilled 
vinegar two and a half ounces, spirits of rosemary the same 
quantity, and fill up to a pint with elder-flower water. Cutting 
the hair short does little or no good, as baldness is a constitutional 
malady, as before stated. The head should never be covered in 
the house, and just as lightly as possible out of doors. A light, 
well ventilated hat is the best head-dress, a close-fitted cap the 
worst. 

Baldness is much more rare in women than in men, as all will 
have observed, much because of their loose head-gear. Does any 
one, I wonder, wear a nightcap in this enlightened nineteenth 
century? If so, let him burn it at once, if he values the health of 
his hair and head. 

Next to the folly of drinking night caps comes that of 
wearing them. Actual baldness is not invariably irremediable, 
but as a rule it is. The same treatment will prove beneficial, but 
stronger stimulants may be required, and before they are applied 
the scalp should be well fomented with warm water. When hair 
begins to grow, frequent shaving does good. 

But on the whole, as regards baldness, its prevention is easier 
than cure. Temporary falling of the hair, after typhoid fever, is 
a very common sequel, but permanent baldness is extremely rare. 
The new hair often lacks lustre at first. It occasionally happens 
that curly hair has grown in these cases in which it w T as previously 
straight, but this condition need not be permanent. 



312 MISCELLANEOUS. 

VALUABLE HAIR TONICS. 

The following tonics for the scalp are of very great value for 
the premature falling out of the hair, owing their action to their 
stimulating properties chiefly : 

R 

Tincture Spanish Flies, two drachms. 

Tincture Red Pepper, two drachms. 

Tincture Nux Vomica, two drachms. 

Castor Oil, two drachms. 

Alcohol, three ounces. 

Spirits of Rosemary, one ounce. 
Mix. Apply to scalp night and morning. 

R 

Pilocarpine Muriate, twenty grains. 

Vaseline, one ounce. 

Lanolin, one ounce. 

Mix. Rub in scalp carefully twice daily. 

HOW TO DARKEN THE HAIR. 

The following receipt will gradually darken the hair and 
surely produce no injurious results. 

R 

Rain Water, one pint. 

Alcohol, two ounces. 

Essence of Rose. thirty drops. 

Powdered Blue Vitriol, two drachms. 

Mix thoroughly and apply once or twice a day. 

FOUL BREATH AND HOW REMEDIED. 

Offensive breath is a functional disorder liable to occur at all 
periods of life. Men are more subject to it than women. It is a 
prominent symptoin of many morbid conditions. The affection 
derives its importance from the fact that it is a constant 
source of great unpleasantness to all who are by force of 



MISCELLANEOUS. 313 

circumstances, compelled to associate with the unfortunate 
person. In its worst forms it effectually destroys the communion 
of friends and the pleasures of social intercourse. Even the har- 
mony of the home circle is invaded by a feeling of repugnance, 
which the best of us can scarcely control. Yet, how few of the 
afflicted persons detect the cause of their isolation, or recognize 
the barrier which effectually prevents the approach of those near 
and dear to them? 

With the best intentions in the world, we rarely whisper a 
word of their disorder or suggest a source of relief — even though 
their breath is as fetid or foul as a pile of offal or carrion. This 
false kindness — this demoralizing weakness is universal. Bad 
breath is caused by numerous disorders, such as nasal catarrh, 
ozsena, necrosis and caries (decay) of the nasal bones, polypi of 
the nose, putrid bronchitis, decayed teeth, etc., etc. But the most 
frequent source of foul breath arises from indigestion or dyspepsia, 
the victims of which are many, and this is a form of the disorder, 
which is very amenable to proper treatment, indeed. In order to 
become acquainted with the sources of the fetor, to be enabled to 
prevent as well as remove the same, we must investigate some of 
the prrysiological working of the animal organism. 

In a work like this such investigation must necessarily be 
brief, and I am compelled for lack of space to limit myself mostly 
to treatment and suggestions as to the appropriate remedies for 
this complaint, coming from whatever source possible. Mental 
emotions, indigestion and habitual constipation are very frequent 
causes of bad breath. Caries of the nasal or jaw bones, ulceration 
of the lining membranes of the nose, mouth, pharynx, larynx, 
trachea, in deeply-seated catarrhal affections or chronic inflamma- 
tion of the bronchial tubes — all constitute possible causes of this 
disgusting affection. 

TREATMENT. 

The first and main step in the successful treatment of this 
affection consists in the discovery and removal of the cause, other- 
wise no permanent benefit will be obtained, as the fetor, or foul 



314 MISCELLANEOUS. 

breath is in fact, only a symptom of some of the numerous dis- 
orders mentioned, and not the disease per se. 

In foul breath from catarrh of the throat or nose, one of the 
best solutions for either gargle or spray is the following : 

R 

Chlorate of Potash, one-half drachm. 

Zymocide, one ounce. 

Glycerine, one ounce. 

Water, four ounces. 

Carbolic Acid, ten drops. 

' Mix. To be applied four or five times a day. 
The reader is respectfully referred to the article on nasal 
catarrh. 

Where the affection is due to habitual constipation, dyspepsia 
or indigestion, a permanent cure can be obtained by following the 
treatment suggested in those articles. The following is an invalu- 
able tablet for dyspepsia with foul breath, and can be obtained at 
any first-class drug store. 

R 

Pepsin, one grain. 

Charcoal, two grains. 

Bicarbonate of Soda, three grains. 

Dose, one to two tablets before meals. 

SPERMATORRHOEA — ITS CAUSES AND CONSEQUENCES — WHY PAR- 
ENTS AND OTHERS SHOULD GUARD THE CHILDREN IN 
THIER CHARGE AGAINST EVIL HABITS. 

We come now to a subject which parents, guardians and 
teachers, out of a mistaken motive, shun like a pestilence, but 
which it is clearly the duty of the conscientious physician to speak 
about, and to speak about plainly, viz: self- abuse (onanism) and 
its invariable result, spermatorrhoea — involutary emission of 
semen. 

Few parents have a conception of the present extent of this 
practice of masturbation among children, especially among boys ; 



MISCELLANEOUS. 315 

neither do they know, until they learn through unpleasant experi- 
ence, what penalties nature may exact for this unnatural abuse of 
its gifts. 

The first, and most common effect of masturbation, is, as 
above stated, spermatorrhoea — more or less frequent, and always 
involuntary, emissions of seed. If these emissions occur nightly — 
and, perhaps, more than once during the same night — they calf for 
remedial measures, although their morbid effects have been much 
exaggerated by unprincipled quacks. Occurring in persons who, 
from an}* cause, are debilitated, these emissions may take place 
without erection or titillation, and with little, or no venereal 
excitement, the afflicted sometimes becoming aware of their occur- 
rence only through the seminal stains. Occasionally these emissions 
take place during the day, when venereal desire is, from some 
cause, excited. These are called diurnal in contradistinction from 
the usual nocturnal emissions. Persons who have been addicted to 
venereal excesses, or to the unnatural habit of masturbation, can 
hardly expect any other result of their course than spermatorrhoea. 

On the other hand, perfectly healthy and virtuous people may 
have occasional involuntary noctunal emissions. If they occur 
infrequently, they are physiological and denote merely a healthy 
state, not a diseased condition, of the system — in other words, 
indicate simply a certain amount of functional activity in the 
genital organs. 

In either case, whether these emissions are natural, or the 
result of vice, every physicians holds, or should hold, in his hand 
the means of cure, providing the patient pursues the course laid 
down for him. And, in this connection, the writer desires to 
especially warn patients afflicted with spermatorrhoea against the 
unscrupulous quacks who flood the land with books, pamphlets, 
lectures, etc. , the sole aim of which is to rob the victims of their 
dollars and cents. Readers, when you see a circular, or adver- 
tisement, headed " L,ost Manhood Restored," " Impotence Surely 
Cured," "Sexual Weakness and the Remedy," be assured the 
whole business is a snare and deception — a trap for the ignorant, 
or inexperienced. Woe be to those who dose themselves with the 
harmful nostrums of these rogues ; their last state will surely be 
worse than the first. 



316 MISCELLANEOUS. 

SEXUAL EXCESSES AND WHAT THEY ENTAIL 

Excessive indulgence in sexual intercourse, or in masturba- 
tion, almost invariably leads to spermatorrhoea, impotence, 
dyspeptic ailments, vertigo, functional disorder of the heart, 
melancholia, hypochondriasis, etc. So it is easy to understand 
that patients require the best of medical treatment and can only be 
injured by quackery. 

Reader, if you suffer through the causes above enumerated, I 
kindly advise you to consult your home doctor, one who, you can be 
certain, is both skilled and conscientious, to whom you can intrust 
y our secret with a certainty of silence and from whom you will 
obtain sure relief, if relief be necessary or possible. 

In conclusion, while excesses in sexual intercourse cannot be 
too severely condemned, there are no words strong enough to 
denounce the sinful and baneful habit of self- abuse — masturbation. 
God himself has set his seal of condemnation upon it (see the 
Scripture account of Onan) , and it is the clear duty of the physician 
not only to endeavor to discover and correct this filthy and 
destructive habit in individuals, but to enjoin upon parents, 
guardians, teachers and associates the great importance of watch- 
fulness, as to this matter, over the young for whose future 
welfare they are, to a greater or less degree, responsible. 

The evils of excessive indulgence of this sort, aside from all 
moral questions, are greater when it is either illicit or unnatural ; 
marital, lawful, God-intended intercourse is beneficial, not pre- 
judicial to good health, but its reverse brings, it may be a slow, 
but a sure, reward of torture and, in some instances, of death. 
While, no doubt, the limits of lawful intercourse may vary in 
accordance with the health and disposition of the parties, their 
constitutional vigor, it may be ordinarily considered as excessive 
if the act of coition is repeated more than a few times a week. If 
married people would bear this fact in mind, there would be less 
complaint, as to their general health, by husbands and wives. 

TREATMENT. 

In the treatment of seminal emissions, the distinction which 
has been made between their physiological and pathological 



MISCELLANEOUS. 317 

significance is to be kept in view. Occurring only now and then 
in a person of full health, in addition to assurances of their harm- 
lessness, it will generally suffice to advise moderation in the use 
of wine or liquors and stimulating articles of food. Saline laxa- 
tives occasionally, cold ablution of the genital organs at night, 
avoidance of undue warmth from the bed or bed-clothes, the mind 
to be diverted as much as possible from provocations of sexual 
desire. If these measures do not suffice, certain anaphrodisiac 
remedies like bromide of potassium, camphor, lupulin or 
tincture of hops, conium and belladonna are called for. When 
the emissions depend upon irritability and weakness of the genera- 
tive organs, these cases are of more importance and the treatment 
is more difficult. Quinine, small doses of strychnine and the 
preparations of iron are useful ; sea-bathing or the sponge-bath 
and out-of-door-life, gymnastic exercise, etc., are valuable 
adjuncts. The diet should be nutritious but not stimulating, and 
alcoholic stimulants are to be interdicted. At the same time 
healthful occupations and chaste associations must constitute the 
moral part of the treatment, which must not be neglected. Taking 
into view all the circumstances in individual cases, it is frequently 
judicious to encourage or recommend marriage, indeed while this 
is always remedial in the milder form of these unhappy cases, it 
likewise not infrequently benefits the most severe forms of this 
affection. 

Spermatorrhoea or these emissionsare apt to follow gonorrhoea, 
and particularly those cases which are protracted or where too 
strong injections have perhaps been employed, and are conse- 
quently dependent more .or less on urethral stricture. The 
successful treatment of such cases requires the use of the bougie 
or sound and cauterizing applications. Seminal losses, indeed, often 
depend on an abnormal sensibility at or near the prostaftic part of 
the urethra (that portion of the canal which is next to the bladder) 
and I have had great success with this mode of treatment. 
Skilled physicians can readily make the application of a weak 
solution of nitrate of silver to these parts of the urethra, provided 
they have the proper instruments. 



318 MISCELLANEOUS. 

HOW TO MAKE ALL KINDS OF POULTICES. 

A cataplasm or poultice is defined as " a soft, but more or less 
coherent, semi-fluid mass placed hot upon the skin for the purpose 
of applying heat and moisture. ' ' They are of very great value and 
owe their utility more to their moisture and warmth than to the 
ingredients of which they are composed. It is well that everyone 
should know the proper way to make these very useful applica- 
tions. They are formed of various ingredients and serve for 
different purposes. Their main use is in the treatment of swollen, 
painful or inflamed parts. They act as sedatives, and thus relieve 
pain and relax the parts to which they are applied — even when 
the pain is deeply seated, and they are excellent adjuncts in the 
treatment of inflammation in general. Poultices of an antiseptic 
nature are invaluable vehicles or applications in all wounds or 
ulcers of an unhealthy, foul or sloughing nature. Large poultices 
are sometimes applied upon the belly to allay pain, as in cramps of 
the stomach"* or pain in the abdomen in general. 

FLAXSEED-MEAL POULTICE. 

Place the ground flaxseed in a basin and pour on boiling 
water, mixing it thoroughly, so there will be no lumps. Spread 
it a quarter of an inch thick upon folded cloth and lay over it a 
piece of cheese cloth. Apply as needed. 

SLIPPERY-ELM POULTICE. 

Moisten the powdered slippery-elm bark with hot water, 
spread and apply as directed for flaxseed poultice. 

BREAD AND MILK POULTICE. 

Break up wheat bread into small pieces and pour on boiling 
milk and stir well until the mass is brought to the thickness of 
mush. Spread upon a cloth and apply to the surface intended to 
be poulticed. Where there is much pain a little aconite or laudanum 
spread on the poultice will enhance its value greatly. 



MISCELLANEOUS. 319 

YEAST POULTICE - 

Take about one pound of oatmeal and add to it one half pint 
of yeast and heat the mixture until it swells. Apply to cloth as 
in other poultices. Antiseptic and good application to bruises. 

CHARCOAL POULTICE. 

Powder fresh charcoal and mix it with bread. Pour on warm 
water and stir it thoroughly and apply in such quantities as may 
be deemed necessary. Used as antiseptic to foul ulcers, etc. 

ONION, TURNIP OR CARROT POULTICES. 

Boil the onions, turnips or carrots and stir in sufficient corn- 
meal to make a thick paste. Apply warm to surface. Used much 
in fetid ulcers. 

MUSTARD POULTICE. 

Mix ground mustard with warm water and apply next to the 
skin, or for milder effects, place a thin cheese cloth between the 
skin and the poultice. 

WHEAT BRAN POULTICE. 

Place the quantity of bran required, according to the size of 
the poultice, upon the top of boiling water, and when the heat has 
penetrated the bran, stir it gently in. Pour off the surplus water, 
and apply the poultice as hot as it can be borne. 

BREAD POULTICE. 

Boil about one-half pint of water in a small, clean, lined 
saucepan ; into this put two ounces of stale bread, and let it soak 
for a few minutes, and apply. 



320 MISCELLANEOUS. 

HEMLOCK POULTICE. 

Hemlock poultices, made by spreading soft extract of hemlock 
on an ordinary flaxseed poultice, are very beneficial in malignant 
painful ulcers. 

A solution of chlorinated soda, when added to a flaxseed 
poultice, is a valuable application to foul, off ensive_ ulcers. 

ABORTION — THE AWFUL CRIME AND ENDANGERMENT TO LIFE 

OF CRIMINAL ABORTION — DOCTOR CATHELL'S EMPHATIC 

DENUNCIATION ON THE SUBJECT. 

Abortion should never be attempted. The term abortion is 
applied to the expulsion of the foetus from the womb, when it 
occurs at a period of pregnancy when the product of conception 
is not yet viable (capable of living outside of the womb) that is 
to say, an abortion may take place at any time between the com- 
mencement of pregnancy and the end of the sixth month. Per- 
sons outside of the profession, often designate abortion under the 
title of miscarriage, but medical men, apply the term miscarriage 
only when the foetus is capable to sustain life outside of the womb 
or after the sixth month and when the birth of the child is prema- 
ture. The causes of spontaneous abortion are very numerous, 
first from the constitution and bad general health of the mother, 
second from diseases of the ovum and third from diseases of the 
womb and its appendages. Abortifacients are medicines capable of 
producing abortion. When taken in doses sufficiently large to pro- 
duce this result, they are all very dangerous to life, and the writer 
cannot too strongly condemn their use and also the person who 
seeks such sinful means, and hereby appropriately quotes on the 
subject from that excellent guide for the young physician, written 
by Dr. D. W. Cathell, of Baltimore, Md., entitled " The Physician 
Himself, ' ' viz ; 

" When you are importuned to produce abortion, on the plea 
of saving the poor girl's character, or to prevent her sister's heart 
from being broken, or her father from discovering her misfortune 



MISCELLANEOUS. 321 

and committing murder, or to prevent the child's father from 
being disgraced, or to avert the shame that would fall on the 
family, or the church scandal, or to limit the number of children 
for married people who already have as many as they want, or for 
ladies who assert that they are too sickly to have children, or that 
their suckling child is too young to be weaned, etc., etc., you 
should meet such entreaties and solicitations with a refusal prompt, 
chilling and emphatic, and never even seem to entertain the 
proposition. If the}* are too importunate, express your senti- 
ments strongly. 

"How could anyone but a fool be induced to take the burden 
from another's shoulders to his own, by doing a crimson crime ; 
to violate both his conscience and the law, to risk exposure, social 
disgrace, and professional ruin, and even the penitentiary itself, 
by putting himself into any one's guilty power, whether as a 
favor or for a paltry f ee ? " 

THE BEST ANTI-FAT REMEDY. 

Youth is over when the weight begins to increase unduly ; it 
is not well to be too fat. For all kinds of work, middle age ought 
to be the best period with men and women, but it is not generally 
so, because most of us are too fat, consequently, too puffy for much 
agility. 

All have the power of preventing themselves getting unwieldily 
stout, but some have much more difficulty than others. 

The cause of too great accumulation of fat arises from over 
eating, and the want of sufficient exercise in the open air. 

This prevents the waste products being removed from the body 
by oxidation. These used-up elements, therefore, instead of unit- 
ing with the oxygen of the air and becoming burnt out of the 
system, as they ought to be, remain behind, and become converted 
into fat. The day laborer may habitually indulge in an amount 
of food without increasing weight, which would add seriously to 
the bulk of a person who led a less active life, because his heavy 
work burns off the excess of food. 

In people who do not become unduly stout, this excess of food 
is either carried off by what we call a bilious attack, an attack of 

22 



322 MISCELLANEOUS. 

gout, or it sets up dyspepsia. Unfortunately, bulk disinclines to 
exertion so that with increase of flesh less work is done, while 
there is a growing disinclination to exert one's self, and in extreme 
cases a repugnance is shown to any form of exercise. These cases 
are among the most difficult to treat, for the sufferer, although he 
may wish for relief, lacks the energy to find it. If walking, 
running, riding, leaping, wrestling, bicycling, and all such exer- 
cises be indulged in, and the diet regulated, very few persons need 
to complain of their obesity. 

Another receipt for reducing the weight is as follows : Eat, 
to the extent of satisfying a natural appetite, of lean meat, poultry, 
game, eggs, milk moderately, green vegetables, turnips, succulent 
fruits, tea or coffee. Drink lime juice, lemonade, and acid drinks. 
Avoid fat, butter, cream, sugar, pastry, rice, sago, tapioco, corn 
starch, potatoes, carrots, beets, parsnips and sweet wine. Exercise 
freely. 

A SURE CURE FOR THE BAD ODOR OF SWEATING 
FEET OR ARMPITS. 

A solution of common soda [impure bi-carbonate] freely ap- 
plied will remove the fetid sweat of the feet and the odorous 
emanations which in some persons escape from the axillary (armpit) 
glands. 

For Freckles, Sunburn and Tan the following wash is a 
valuable remedy : 

R 

Carbonate of Potassa, three drachms. 

Chloride of Soda, two drachms. 

Rose water, eight ounces. 

Orange Flower Water, two ounces. 

Mix and apply with sponge four or five times a day. 

A very strong solution of borax in rosewater is also a useful 
application to remove freckles, and can do no harm, even if it fail 
to cure. 



MISCELLANEOUS. 323 

AGENTS FOR REMOVING SUPERFLUOUS HAIR. 

It is frequently desirable to remove hairs from parts where 
they are unsightly, as we so often see in women, growing on the 
arms and especially on the upper lip, thus constituting genuine 
moustaches. These can, however, be satisfactorily removed with- 
out pain as follows : Take equal parts of yellow sulphate of 
arsenic and quick-lime, make into a paste with hot water and 
apply to the hairy skin and allow the same to dry when the hair 
can then be wiped away without the least inconvenience. It will 
thus remove the hair for 20 days and often permanently. Elec- 
trolysis is the method of removing hair by electricity, and is pre- 
ferable to the above mentioned plan of treatment in getting rid 
of strong hairs from moles and in the removal of moles themselves, 
especially such as contain many blood vessels. 

Health Notes. 

for swollen feet. 

Policemen, mail carriers, and others whose occupation keeps 
them on their feet a great deal, often are troubled with chafed, 
sore and blistered feet, especially in extremely hot weather, no 
matter how comfortably their shoes may fit. A powder is used in 
the German army for sifting into the shoes and stocking of the 
foot soldiers, called Fuss-Slreu-pulver, and consists of three parts 
salicylic acid, ten parts starch, and eighty- seven parts pulverized 
soap-stone. It keeps the feet dry, prevents chafing, and rapidly 
heals sore spots. Finely pulverized soap-stone alone is very good. 

HOW TO DUST THE SICK-ROOM. 

A sick-room that needs cleaning can be made fresh and sweet 
without sweeping and without dust, by wiping everything in it 
with a cloth wrung out of warm water in which there are a few 
drops of ammonia. The rugs and draperies, though there should 
not be any in the room, the doctors tell us, may be put upon the 



324 MISCELLANEOUS. 

line for a thorough airing and wiped in the same way. The 
feather duster, which should be banished because it does no real 
good any way except to stir up and redistribute the dust, is 
especially out of place in the sick-room, where there may be and 
doubtless often are, germs of disease in the innocent-looking dust. 
If a patient is in a nervous state a screen may be placed in front 
of the bed while the freshening goes on. If the room can only be 
heated by a stove, the noise of putting in coal can be deadened by 
wrapping the coal in a paper before putting it on the fire. 

TOBACCO IN THE BITE OR SCRATCH OF A DOG OR CAT. 

For a bad cut or scratch from a dog or cat one of the speediest 
remedies to draw out poison, and at the same time heal the wound, 
is tobacco. Moisten a little chewing tobacco, either leaf or fine 
cut, and bind it on the wound. Unless very serious you will 
hardly know at the end of twenty-four hours that you have been 
hurt. 

THE CURE OF A BUNION. 

A bunion may be cured b} T bathing the affected part in hot 
water to which a teaspoonful of salt, a tablespoonful of starch and 
a few drops of arnica have been added, then wipe dry with a soft 
linen towel and apply iodine with a camel's hair brush. Wear a 
loose shoe all the time or one which has the leather covering the 
bunion cut out. Bunions are caused by undue pressure. A good 
plan, if you have to be out a good deal, is to have the shoemaker 
cut a piece from your shoe where it presses upon the bunion and 
replace it wdth an invisible patch. 

TO CURE A STY. 

To cure a sty, take the white of an egg on a saucer and rub 
into it a small pinch of powdered alum. It will become a curd. 
Put it between two pieces of muslin lawn and bind it over the eye 
before retiring for the night. In the morning the sty w T ill be gone, 
or much better. One more application will be sufficient and no 
more sties will come. 



MISCELLANEOUS. 325 

GOOD HEALTH. 

It may be said, I think with truth, that good health depends 
upon the harmonious relationship and rational use and conserva- 
tion of the forces vvhich carry on, as it were, the life of body, 
mind and spirit. In this earthly existence man is a complex 
creature. He is neither body, mind, nor spirit alone, but the three 
in one, inter-related, inter-dependent. If there is misappropria- 
tion, misdirection, misuse, waste of force in the case of one, the 
whole must suffer. One can not be overtaxed, or starved, or per- 
verted from its right uses without injury and loss to all. 

PROPER DIET FOR CHILDREN. 

Children under two years of age are generally best fed on 
milk and milk foods, and the less this is departed from, as a rule, 
the better. Under this age they should never be taken to the 
table, for it only gives the child a fancy for articles of diet which, 
if it never saw, it would never want. In the great majority of 
cases, children have not much desire for animal food of any sort 
until the first dentition is over, unless the craving is fostered in 
them by their being given one thing and another to eat, and thus 
there is created what is almost an unnatural appetite. This, of 
course, is not intended to be an absolute rule, for many children 
want, and seem to need, after the first year, a meal once or twice 
a day of something besides bread and milk. But no mother should 
feel uneasy if her child takes almost nothing but milk and bread 
and butter until after it is two years of age. 

TREATMENT OF INGROWING NAILS. 

A very common and troublesome affection is that which is 
popularly termed "the ingrowth of the nail," and which most 
usually occurs by the side of the great toe. There is really no 
alteration in the nail, as its name would imply ; the surrounding 
soft parts are first swelled and inflamed by constant pressure 
against the edge of the nail from the use of tight shoes. If this 
state is permitted to continue, an ulcer is formed in which the 



326 MISCELLANEOUS. 

edge of the nail is imbedded. Pain is the consequence, sufficiently 
severe in some instances to prevent walking. Treatment for this 
condition often demands the skill of a physician. The sufferer 
might attempt a cure by the simpler methods, and if they fail, 
professional assistance should be sought. The first object is to re- 
move the cause, then to lessen the irritation and reduce the swell- 
ing. After soaking in hot water the nail should be thinned by 
scraping, and, if very painful, a flaxseed poultice will bring relief. 
After the irritation has sufficiently subsided, soft cotton should be 
pressed between the flesh and the nail, and, after that is done, it 
should be saturated with the tincture of iodine, and the applica- 
tion repeated several days, after which the tenderness will disap- 
pear. It may be necessary to lift the end of the nail, and this can 
be done by pressing cotton between it and the toe. This treatment 
is usually effective, and is attended with as little pain as any which 
can be suggested. 

The injection of a solution of cocaine at several places in 
vicinity of the nail, renders the operation altogether painless. 
The removal of the entire nail which the skilled surgeon can very 
readily accomplish, is the better method. The operation can be 
rendered painless, by the use of cocaine, and the result is always 
highly satisfactory, a new and complete nail growing immediately. 

DO NOT SLEEP ON YOUR LEFT SIDE. 

When a patient complains of a bad taste in his mouth every 
morning on waking up, the first question I ask him is as to the 
position he assumes when going to sleep. An immense number of 
people sleep on the left side, and this is the most common cause of 
the unpleasant taste which is generally attributed to dyspepsia. If 
a meal has been taken within two or three hours of going to bed, 
to sleep on the left side is to give the stomach a task which it is 
difficult in the extreme to perform. The student of anatomy 
knows that all food enters and leaves the stomach on the right 
side, and hence sleeping on the left side soon after eating involves 
a sort of pumping operation which is anything but conductive to 
sound repose. 



MISCELLANEOUS. 327 

The action of the heart is also interfered with considerably, 
and the lungs are unduly compressed. It is probable that lying 
on the back is the most natural position, but few men can rest 
easily so, and hence it is best to cultivate the habit of sleeping on 
the right side. It is very largely a matter of habit, and the 
sooner it is acquired the better for the sleeper and the worse for 
the physician. 

HOW TO PRESERVE THE TEETH — THE BEST TOOTH-POWDER — 

LISTER I NE, THE MOST EFFECTIVE, HYGIENIC, AS WELL 

AS THE MOST ELEGANT MOUTH-WASH. 

Much has been said and written of late in reference to the 
preservation of the teeth. I find in practice that it is a difficult 
task to get the patient to follow the instructions of the dentist 
regarding the care of the teeth. 

It is a fact well demonstrated that the dentist is often called 
on to extract a tooth which might have been useful to its owner 
for many more years, if it had received proper care and attention. 

We all argue — and justly — scrupulous cleanliness as much 
depends on the patient as on the dentist if they wish to keep 
nature's gift, and no amount of professional skill will keep the 
teeth unless care is taken of them by the patient. 

One of the most skillful dentists in New York gives these rules 
for the care of the teeth : 

Use a soft brush and water the temperature of the mouth. 
Brush the teeth up and down in the morning, before going to bed 
and after eating, whether it is three or six times a day. 

Special care to brush well around the posterior teeth, inside 
and out. Followed by waxed floss silk or narrow elastic bands 
between the teeth, avoiding the gums as much as possible. This 
keeps the surfaces, especially those on the sides of the teeth 
touching each other — the approximal sides — clean. Food allowed 
to lodge there will inevitably decay. 

Use a tooth powder twice a week, not oftener, except in case 
of sickness, when the acids from a disordered stomach are apt to 
have an unwholesome effect upon the dentine. Avoid all tooth 



328 MISCELLANEOUS. 

pastes and dentifrices that foam in the mouth ; the lather is a sure 
sign of soap, and soap injures the gums without in an}^ way 
cleansing the teeth. 

The very best powder is of precipitated chalk ; it is absolutely 
harmless and will clean the enamel without affecting the gums. 
Orris root or a little wintergreen added gives a pleasant flavor, 
but in no way improves the chalk. At least a quart of tepid water 
should be used in rinsing the mouth. A teaspoonful of listerine 
in half a glass of water used as a wash or gargle after meals is 
excellent ; it is good for sore or loose gums ; it sweetens the 
mouth and is a valuable antiseptic, destroying promptly all odors 
emanating from diseased gums and teeth. Coarse, hard brushes 
and soapy dentifrices cause the gums to recede, leaving the dentine 
exposed. Use a quill pick if necessary after eating, but a piece 
of waxed floss is better. These rules are worth heeding. 

Be assured of the genuine listerine by purchasing an original 
bottle. 

If you have an artificial denture, I caution you to keep it 
scrupulous^ clean. Many mouths are made sore by lack of care 
in this respect and the plate is unjustly blamed. If it is a vulcanite 
(rubber) plate, I advise 3 T ou to use sapolio with a plate brush to 
thoroughly cleanse it. 

The necessity of having the mouth examined twice a year is 
strongly advised, as cavities may exist and develop, which are not 
discovered until the nerve (pulp) of the tooth is exposed and pain 
ensues, which may indicate grave and serious results, often causing 
the loss of the offender. 

In conclusion, let me say, that the dentist himself, should be 
very cautious about prescribing tooth-powders, or dentifrices, as 
many of these so-called dentifrices contain acids, charcoal, alum, 
etc. , which are gritty and decidedly injurious to the teeth. A good 
tonic astringent mouth wash much more serviceable and effec- 
tive, keeping the gums and mouth in a healthy hygienic condition, 
and aided by the brush and tepid water, the teeth are kept clean 
and are preserved for years of usefulness and beauty. 



VOCABULARY, 



Abdomen (ab-doh'-men.) [X. , probably from abdere, to hide.] 

That portion of the trunk situated between the diaphragm 

and the pelvis. 
Ablution (ab-lew'shun.) [L. albutio, from abluere, to wash off.] 

Purification by washing. 
Absorbent Cotton. [L. absorbms, to suck up.] Cotton deprived 

of its fatty matter by treatment with alkalies, and so rendered 

fit for absorbing water, etc. 
Accoucheur (a-koosh-ur'.) [F.] A male who delivers women. 
Actual Cautery (ak'tew-al kaw'tur-ee.] A hot iron used in 

cauterization. 
After-pains. Pains due to uterine contraction occurring in the 

days following labor. 
Albumen (al-bew'men.) [1^. , from a/bus, white,] The white of 

an egg. 
Aliment. [X. alimen'tum, from alere, to nourish.] Food. 
Alkalies (al'ka-li.) [Ar. alqali, potash.] Substances which have 

the power of restoring the blue reddened by acids. 
Alterative (awl'tur-ative.) [%. alt'erans.] A medicine producing 

gradual change. 
Amylaceous (a'mi-lay'shus). Starchy. 

Anaemia. A state in which the blood is deficient either in quan- 
tity or quality. 
Ahthelmin'tic. A remedy against worms. 
Antidote. A remedy given to counteract a poison. 
Antipyretic. Opposed to fever. 
Antisep'tic. Preventing putrifaction. 



330 VOCABULARY. 

Apyrexia (ap'ey-rek'see-ah.) Absence of fever. 

Asep'sis. Absence of infection ; freedom from morbid germs. 

Assiin'ila'tion. The process by which bodies appropriate and 
transform other matters into their own substance. 

Atrophy (at'ro-fee. ) Wasting away. 

Aus'culta'tion. The act of listening, as applied to the heart and 
lungs. 

Axill'a. The armpit. 

Belch To expel wind forcibly from the stomach. 

Bistoury (bis'tur-ee) A small narrow bladed knife used in surgery. 

Borborygmus (bor-bo-rig'mus.) A rumbling of the intestine. 

Bougie (boo-zhee.) An instrument shaped like a candle for dilat- 
ing mucous canals. 

Cadaver (ka-day'vur.) A dead body. 

Csesarean Section (see-zay'ree-un.) The operation of removing 
a child from the uterus by incision through the abdomen. 

Calculus (kalk'yu-lus.) A stone. 

Call'us. The new material thrown out to unite the fracture of a 
bone. 

Cap'illary. Hair-like in size. 

Capsule (kaps'yuhl.) A membranous expansion inclosing a part. 
2. A gelatinous envelope in which medicines may be given. 

Cardi'tis. Inflammation of the heart. 

Carcino'ma. Cancer. 

Caries (kay'ree-eez.) Ulceration of bone. 

Carmin'ative. A remedy which allays pain by causing the expul- 
sion of wind from the alimentary canal. 

Cat'alepsy. A disease in which there is sudden suspension of the 
senses and of the will, the body remaining in whatever pos- 
tion it is placed. 

Cat'amen'ia. The menstrual discharge. 

Cataplasm. A poultice. 

Causal (kaw'zul.) Directed toward the cause of a disease. 

Caustic (kaws'tik.) A substance which burns living tissues. 

Cer'vical. Pertaining to the neck. 

Cholagogue (kol'a-gog. ) A medicine increasing the flow of bile. 

Cholera (korur-ah. ) An infectious epidemic disease. 



VOCABULARY. 331 

Cicatrix (si-kay'-triks.) A scar. 

Circumscribed. Distinctly limited. 

Clin'ical. At the bedside. 

Clyster. An enema. 

Coagula'tion. Curdling of a fluid. 

Collapse' . Complete prostration of the vital powers. 

Colly'rium. Eye wash. 

Colos'trum. The first milk secreted after confinement. 

Coma (koh'mah.) A state of profound insensibility. 

Com'plex. Complicated. 

Congen'ital. Exisiting from birth. 

Congestion . The accumulation of blood in any organ. 

Conjunctivitis (kon-jungk'-ti-vey'tis. ) Inflammation of the con- 
junctiva. 

Coryza (ko-ri-'zah.) Catarrh, snuffles. 

Coun'ter-irritation. Irritation excited in any one part of the body 
to relieve another. 

Cramp. A painful, convulsive contraction of a muscle ; a spasm. 

Crisis (krey'sis. ) The turning point in a disease. 

Cyanosed. Blue. 

Cystitis (sis-tee'tis.) Inflammation of the bladder. 

Decoc'tion. i. The operation of boiling certain ingredients in a 
fluid. 2. The result of such boiling. 

Defecation (def 'ee-kay-shun.) The discharge of fecal matter. 

Dementia. A form of insanity usually acquired which is char- 
acterized by great impairment of the memory and will. 

Demulcent (dee-mul'sent.) Soothing. 

Deodorant (dee-oh'dur-ent. ) Destroying odors. 

Diagnosis (dey'ag-noh'sis.) Distinguishing one disease from 
another. 

Diaphragm (dey'a-fraem.) The large muscle separating the chest 
from the abdomen. 

Diathesis (dey-ath'ee-sis.) A peculiar disposition or condition of 
the system. 

Dietetics (dey'e-tet'iks.) A branch of medicine comprising rules 
of diet. 

Digital (dij'i-tul.) Pertaining to the fingers. 



332 VOCABUI.ARV. 

Disinfectant. An agent which destroys septic germs. 

Diuresis (dey'yu-ree-sis.) An increased excretion of urine. 

Douche (doosh.) A column or shower of fluid. 

Dysphagia (fay'jah.) Difficulty in swallowing. 

Dyspnoea (disp-nee'ah.) Difficulty in breathing. 

Dysuria (dis-ew'ree-ah.) Difficult and painful passage of urine. 

Ec'zema. An inflammatory affection of the skin. 

Embrocation (em'broh-kay'shun.) A liniment. 

Emesis. The act of vomiting. 

Kmmenagogue. A medicine promoting the menstrual discharge. 

Emollient (ee-moryent.) Substances which relax and soften the 

tissues. 
Emulsion. A mixture of oil and water. 
Endemic. Peculiar to a locality. 
Endocarditis (endo-kahr-dey'tis. ) Inflammation of the lining 

membrane of the heart. 
Enter'ic. Intestinal. 

Epidem'ic. A disease attacking many people. 
Epistax'is. Hemorrhage from the nose. 
Eructation. Bringing up gas from the stomach. 
Escharotic. A substance which occasions sloughing. 
Exacerbation (ex-as'ur-bay'shun.) An increase in the symptoms 

of a disorder. 
Ex anthem' ata. The eruptive fevers. 

Excoriation (eks-koh'ree-ay'shun.) An abrasion of the skin. 
Excre'tion. The throwing off of waste matter. 
Expec'tant. Treatment by leaving disease to nature. 
Extirpation (eks'tur-pay'shun.) Complete removal. 
Extrin'sic. Coming from outside. 
Fauces (faw-seez.) The throat. 
Febrile (feb'ril.) Pertaining to fever. 
Fissure (fish'ur.) A crack. 

Fistula (fist'yu-lah.) A false opening into the soft parts. 
Flatulence (flat'yu-lens.) Gas in the alimentary canal. 
Foetus (feet/us.) Young of any animal in the uterus. 
Fontanelle (fon'ta-nef.) Spaces between the cranial bones in the 

young child. 



VOCABULARY. 333 

Fumigation. Charging the air with gas or vapor. 

Function. The office or duty of an' organ. * 

Fun'dus. The base. 

Fus'ible. Capable of being melted. 

Gang'rene. The first stage of mortification. 

Gesta'tion. Pregnancy. 

Gland. An organ having the function of secretion. 

Globus hystericus. The sensation as of a ball in the throat. 

Goitre (goy'tur.) Enlargement of the thyroid gland producing a 

swelling in the front of the throat. 
Gynaecology (jin'e-kol'o-jee) A branch of medicine treating of 

disease of women. 
Hsematemesis (hein'a-tem'e-sis.) Vomiting of blood. 
Haematuria (hem'a-tew'ree-ah.) Blood in the urine. 
Haemoptysis (hee-mop'ti-sis.) Spitting of blood. 
Haemostatic (hee'moh-stat'ik.) An agent to stop hemorrhage. 
Hydragogue (hey'dra-gog,) A medicine causing watery evacua- 
tions. 
Hyperaemia. An excess of red corpuscles. 
Hyperpyrexia. Very high fever. 
Idiosyncrasy (id'ee-oh-sin'kra-see.) Peculiarity. 
Incubation. Hatching. The period between the reception of a 

poison and the appearance of the symptoms. 
In'dolent. Giving little or no pain. 
In'dura'tion. Hardness — swelling. 
Infection. The communication of disease. 
Infusion, i. The process of steeping a substance in fluid. 2. The 

resulting liquor. 
In'tus-suscep'tion, The slipping of one part of the intestine into 

another. 
Irrigation. Regular and continuous washing of a part. 
Irritation. Excess of vital movement, usually manifested by 

increase of circulation and sensibility. 
Jaundice (jawn'dis.) Yellowness resulting from some obstruction 

in the course of the bile. 
Laparotomy. Opening the abdomen. 
Lateral . On the side. 



334 VOCABULARY. 

Leth'argy. Stupor. 

Ligation. Tying. 

Lig'ature. The thread used for tying a vessel. 

Lochia (k>h'kee-ah,) The discharge of blood and serum following 

child-birth. 
Luxa'tion. A dislocation. 
Lymph, i. The fluid contained in the lymphatic vessels. 2. The 

fluid poured out in adhesive inflammation. 
Malaria. A disease produced by the noxious inhalations from 

marshy localities. 
Malaise (mah-layz.) Indisposition. 
Malingery (ma-lin'jur-ee.) Feigning disease. 
Maras'mus. Wasting away. 
Menorrhagia. Excessive menstruation. 

Metastasis (mee-tas'ta-sis.) A change in the seat of a disease. 
Micturition. The act of passing water. 
Morbid. Diseased. 
Morbific. Causing disease. 
Moribund. About to die. 
Mortification. Loss of life in a part. 

Multipara. A woman who has given birth to several children. 
Naevus (nee'vus. ) A birth-mark. 
Nares (nay'rees.) The nostrils. 
Nates fnay'teez.) The buttocks. 
Nostralgia. Home sickness. 
Noxious. Unwholesome ; harmful. 
Nutrient. Nourishing. 
Oesophagus. The gullet. 
Odontalgia. Toothache. 
Obstetrics. Midwifery. 
O'lea'ginous. Oily. 

Olfac'tory. Relating to the sense of smell. 
Onj^chia (oh-nik'ee-ah.) An abscess at the side of the finger-nail 

— felon. 
Os'seous. Bony. 

Os'sifica'tion. Conversion into bone. 
Ovum. The embryo and its membranes. 



VOCACULARY. 335 

Pall'iative. Alleviating. 

Panacea (pan'a-see'ah.) A universal remedy. 

Paracente'sis. The operation of tapping the chest. 

Parasiticide (sit'i-seyd.) An agent that kills parasites. 

Percus'sion. Striking on a body to elicit sounds — as in examining 

the chest. 
Peristalt'ic. Undulating or worm-like. Applied particularly to 

the motions of the intestines. 
Pharmacopoeia (fahr'ma-koh-pee'ah.) A book giving directions 

for making medicines. 
Placen'ta Prsevia. The attachment of the placenta over the 

mouth of the uterus. 
Polypus (pol'ee-pus.) A kind of tumor occurring in mucous 

membranes. 
Primip'ara. A woman who bears her first child. 
Prognosis. A prediction of the course of a disease. 
Prophylaxis (pro-fi-lak'sis.) Prevention. 
Ptyalism. Salivation. 
Purulent. Having the character of pus. 

Quickening. The first movements of the foetus felt in the uterus. 
Refrigerant (re-frij'er-ant.) Producing cold. 
Reg'imen. Regulation of diet. 

Regurgitation. Throwing back a portion of the contents. 
Respiration. Breathing. 

Retention. The act of holding or keeping in as the urine. 
Rigor (rey'gawr.) A chill. 

Rigor mortis. A stiffening of the muscles occuring after death. 
Ru'befa'cient. A substance or external application which produces 

a redness of the skin. 
Rubeola. The measles. 
Saccharine (sak'ur-in.) Containing sugar. 
Salivation (sal'ee-vay'shun.) Excessive secretion of saliva. 
Sat'ura'tion. The union of one substance with another until it 

can take no more. 
Scybala (sib'a-la.) Hard lumps of faecal matter. 
Sepsis. Putrefaction. 

Sequelae (see-kwee'lah.) Morbid phenomena resulting from dis- 
ease. 



336 VOCABULARY. 

Show. A vaginal discharge occurring just before labor. 

Singultus. Hiccough. 

Slough. A dead portion separating from the living. 

Sordes (sawr'deez.) An accumulation of the secretions of the 

mouth upon the teeth. 
Sporadic. Occurring in single or scattered cases. 
Steth'oscope. A tube for conveying sounds from the chest to the 

ear. 
Strangury (strang'gew-ree.) Slow and painful passage of urine. 
Stupor. Profound unconsciousness. 
Styptic (stip'tik.) Astringent. 
Sudoriferous (seu'dur-ifur-us.) Sweat-bearing. 
Sutures (sew'chur.) i. The articulations of the bones of the 

skull. 2. Stitches for holding together the edges of a wound. 
Syphilis (sif 'i-lis.) An infectious venereal disease. 
Tampon. A plug. 
Tetanus, A disease characterized by continuous muscular spasm 

locked- jaw. 
Toxic. Poisonous. 
Tum'efac'tion. Swelling. 

Tympanites (tim'pa-ney'teez.) Distention of the abdomen by gas. 
Umbilicus. The navel. 

Ure'a. The nitrogenous constituent of the urine. 
Vascular. Full of vessels. 
Vi'able. Sufficiently developed to live. 
Vis'cera. The internal organs. 
Vis'cus. Singular of viscera. 
Wet-pack. A wrapping of wet sheets in which a patient is 

enveloped in the hydropathic treatment. 



INDEX 



Abortion, 320. 

Abbreviations and Symbols in Medi- 
cine, 81-82. 

Accidents and Emergencies in 
general, r-2. 

Air and Ventilation — Effects upon 
Health — Bed-rooms — Methods of 
Ventilation — The need and use 
of Sunshine — Proper care of 
School Houses during vacation, 
172-177. 

Ambulance, use of, 3. 

Anti-Fat Remedy, 321. 

Antiseptics, 178. 

Aphasia, 256-258. 

Aphonia, 256. 

Appendicitis, 220. 

Arsenic, 49. 

Asphyxia — from drowning, from 
strangulation, from narcotic poi- 
sons, from charcoal, from illum- 
inating gas, from foreign bodies 
in the throat and wind pipe, 
15-24. 

Asthma, 219-220. 

Baking Soda in burns, 11. 
Blood — its quantity, corpuscles, 

function, 306-307. 
Blood — letting, cupping and leech- 

ing, 78. 
Boils and Carbuncles, 39. 
Bre&th — foul, how remedied, 312-314. 
Bright's Disease, 254-256. 
Bronchitis — in adults, 221-224. 
Bronchitis — in children, 224-226. 
Bunions, 324. 
Burns — treatment, 10,11,12,13,14. 

Catarrh of the Nose — Chronic Nasal 
Catarrh, 217-219. 



Cellars — How to Disinfect, 178-183. 

Chilblains, 34. 

Children — Home Treatment of, 203. 

Chicken-pox, 301. 

Chorea, or St. Vitus' Dance, 210-213. 

Cholera — Asiatic — Its Prevention, 
285-287. 

Cholera Infantum, 197-201. 

Cholera Morbus, 193. 

Constipation — Habitual — Causes and 
Treatment, 168-171. 

Consumption — Pulmonary — Preven- 
tion and Treatment, 230-238. 

Contagion and Disinfection — Mi- 
crobes in Water and Atmos- 
phere — Sterilization and Disin- 
fection, 178. 

Convulsions in Children, 204. 

Cramps — Gastralgia or Stomach 
Cramps- -Treatment, 164-168. 

Croup, 205-207. 

Delirium Tremens, 287-260. 

Diabetes, 249-251. 

Diarrhoea, 253-254. 

Diet for children, 325. 

Digestion — Food for the sick and its 
administration — Cooking for the 
sick — Alcoholic stimulants, their 
use and abuse — Diet and how to 
vary it — Milk aud its impurity — 
Safeguards — Infant foods — Food 
at the bed-side — Overloaded 
plate — variety in food, etc., 143, 

156, 1 57- 
Diphtheria — cause and the Anti- 

toxine treatment 1, 78-183-296-299. 
Dropsy — Following Scarlet Fever 

279-281. 
Dysentery, 251-253. 
Dyspepsia or Indigestion, 158-164. 



23 



338 



INDEX. 



Ear — Foreign Bodies in, 26. 

Earache — Treatment, 39. 

Epilepsy or Falling Sickness, 243-246. 

Erysipelas, 291-292. 

Exhaustion, from heat, 32. 

Eye — Forrign Bodies in, 25. 

Faceache, 42. 

Fainting or Syncope, 9. 

Fear as a Factor of Disease and 
Death 305-3C6. 

Fetid Perspiration — of Feet — of 
Armpits, 322. 

Fever and Ague, 258-270. 

Fever — Typhoid and Scarlet— Pre- 
vention of, 178. 

Fractures and Dislocations, 3,4,5. 

Frost-bite— Treatment. 33-34 

Gleet, 117. 

Gonorrhoea — In the Male — Its Caus'e, 
Origin and History — Source of 
Contraction — Prominent Au- 
thorities on the Subject — Safe- 
guard Against — Symptoms — 
Treatment. Dangers Resulting 
from Improper Treatment — In- 
valuable Recipes — In the Female 
—Parts Affected— Infallible Re- 
cipes, 104-119, 120-123. 

Health — How Preserved, 325. 

Health Notes, 323. 

Hair — To Remove Superfluous — 

Care of Hair and Prevention of 

Baldness, 310-312, 323. 
Headache — Varieties — Cause, 40, 239 

-242. 

Infants — Care of during Hot Weather 

201-202. 
Insomnia, 304. 
Itch or Scabies, 292-296. 
Ivy Poisoning — treatment, 37. 

Jamestown or "Jimson" Weed, 55. 

Lactation — Wet Nursing — Disadvan- 
tages of Artificial Nursing — Sore 
Breasts and Other Resultant Dis- 
eases — Mechanical Means — Diet 
and Medical Agents— To Pro- 
mote the Flow of Milk — Valu- 
able information — Sore Nipples 
— Treatment, 135-142. 



La Grippe — Origin, History and 
Treatment. 270-273. 

Leucorrhcea, or the Whites — Its 
Causes, Source, . etc. — Leucor- 
rhcea in Children — Its Origin, 
History and Treatment, 100-103. 

Lice — Crab, Head aud Body, 795-29^. 

Lightning — Accidents from, 35-36. 

Malaria, 258. 

Medical and Hygienic Agents, Their 
Action, 78-79. 

Medicines — Their Modification, Ac- 
tion, Influence, Application and 
Classification According to Their 
Action on the Animal Economy, 

83-85- . 

Menstruation — Causes, Disorders of, 
Amenorrhcea. Absence of, Chlor- 
osis or Green Sickness, Painful 
or Dysmenorrhcea, Menorrhagia 
or Excessive, Vicarious Men- 
struation, 92-99. 

Mercury, 51. 

Morphine, Its Uses, 59. 

Mothers' Medicine Box of Home 
Remedies, 194-196. 

Night-mare, or night-terrors of chil- 
dren, 192. 
Nose — foreign bodies in, 27. 
Nursing — Care of the sick, 184-187. 

Onanism, 314. 
Opium, 59. 

Piles, or Hemorrhoids, 246-248. 

Pleurisy, 230. 

Pneumonia, in adults 226-229. 

Pneumonia, in children 22Q-230. 

Poisons, Vegetable, antidotes — 
Stramonium, belladonna, hen- 
bane, opium, morphine, strych- 
nine, nux vomica, digitalis, 
aconite, indian tobacco, tobacco, 
oil of tansy or savine, mush- 
rooms, poisonous meats and 
fish, 55-68. 

Poisons in general — antidotes, 43-44 
-45- 

Poisons and their Antidotes, tabulat- 
ed, 69-77. 

Poisoning, from carbolic acid, from 
lunar caustic, iodine, alcohol, 
arsenic, lead, mercury, anti- 



INDEX, 



339 



mony, ammonia, copper, phos- 
phorus and zinc, 46-54. 

Poultices, their use, how to make, 38 
-3' 8-3 1 9-3 2 o. 

Pulse, 309. 

Quincy, or Tonsilitis, 215-217. 

Quinine, Its Origin, Discover} 7 and 
History, Its Use and Abuse, Its 
Results, Its Value in Certain 
Diseases, etc., ^6-91. 

Scarlet Fever — its Origin, History, 
prevention and Treatment, 274- 
279. 

Sciatica, 248-249. 

Self-Pollution, or Masturbation, 314- 

315. 

Sexual Excesses, 316. 

Sexual Relation — Society's Serious 
Mistakes — Maid and Lover — 
Man and Wife — Consequences of 
Violating Laws of Nature — The 
Limitation of Families, 124-134. 

Shock or Collapse, 7-8. 

Sick-Room — How to Dust, 324. 

Sleep — Proper Position, 327. 

Small-pox, 299-300. 

Spitting of Blood, 37. 

Sprains 5. 

Stretcher, L T se of, 3. 

Strychnine 61. 

Stye, 325. 



Sunstroke — Cause, Prevention and 
Treatment, 28-31. 

Teeth, 41-327. 
Testicles — swelled. 118. 
Temperature — Atmospheric, 310. 
Temperature — in sunstroke, bodily, 

vital, 28,307-308. 
Thermometer — Fever, use of, 308. 
Tobacco— -its use in Dog and Cat 

bites, in medicine, 65-324. 
Toe Nails — ingrowing, 326. 
Toothache, 41. 
Tvphoid Fever, and its prevention, 

281-284. 
Typhus Fever, 284-285. 

Urethritis, 104. 

Varioloid, 300. 

Vomiting— How to Check It, 37 

Weights and Measures, 80. 

White of Eggs in Burns, 11. 

Whitlow, or Felon, 38. 

Whooping Cough 208-209. 

Worms— Varieties of, in Intestines, 
Symptoms, Cause, Diagnosis, 
Their Removal— Proper Worm 
Mixtures, 188-19 1. 

Wounds — Contused, Incised, Lacer- 
ated, Punctured, Poisoned, Gun- 
shot, 15-20. 



TESTIMONIALS. 



Dr. W. P. Kistler has devoted a great deal of his valuable time and study during the 
last eight months in the compilation of a medical work, entitled " Practical Medical and 
Surgical Family Guide in Emergencies," designed for teachers, students, families, the 
busy practitioner and the public in general — a book for ready reference and instruction on 
almost all topics relating to physical welfare, both in health and disease. Judging from 
the prospectus just issued, the effort will meet with great success and net the doctor a 
substantial source of income. 

The book will be sold by subscription only and will contain twenty-six chapters com- 
prising about 350 pages, the manuscript of which is now in the hands of the publishers, 
Messrs. Berkemeyer, Bechtel & Co., of this city. 

That Dr. Kistler is well fitted by extended experience in the practice of his profession 
to get up such a work there can be no doubt, and in his preface he well says: "Observations 
during a long and busy professional career have impressed the writer with the belief that 
a book giving plain directions as to what should be done in cases of disease and of the 
commoner accidents and poisoning, as well as the means of studying some of the laws 
that govern and regulate our being, would be of decided benefit, not only to families, 
teachers, etc., but to the laity generally. It is with such an end in view that this manual 
is placed in their hands, presenting succinctly but at the same time in a sufficiently 
comprehensive manner the treatment of the many emergencies which are continually 
arising in our eve ry-day life." 

The book differs very materially from the usual run of family medical works, not only 
in its plain and practical instruction, but in the manner in which it imparts the most 
valuable information. His information on physiology, anatomy and Materia Medica will 
prove of untold benefit to the people, and a copy of the work should be in every family. 
It is provided with a pronouncing vocabulary and all difficult medical terms are thus 
simplified and easily understood. The work is of such general merit that it will have a 
ready sale in this community. 

— Allentown Daily City Item. 

For many months it has been noised about that Dr. W. P. Kistler, who for over a 
quarter of a century has successfully practiced his profession in this county, was writing 
a book. The prospectus has at last made its appearance, and a careful examination of the 
table of contents convinces one that much labor and scientific research has been expended 
in its compilation. The work is entitled " Practical Medical and Surgical Family Guide 
in Emergencies," and will certainly be a valuable acquisition to any library. 

Not only does it differ materially from all other works of the kind heretofore 
published, but it is written in such a simple and instructive style that it can be read and 
easily understood by all classes, and on this account is well deserving of public patronage. 
Dr. Kistler needs no eulogium as to his professional abilities. After so long and successful 
a career as a family physician he must certainly be fully conversant with the necessary 
requirements for the preservation of health. The book is dedicated lo the Rev. Dr. Home. 

— Allentown Daily Leader. 

The readers of the Critic are no doubt aware that W. P. Kistler, M. D., of this city, 
has been devoting mnch of his valuable time to the compilation ot a medical work for the 
laity, entitled " Practical Medical and Surgical Family Guide in Emergencies," accidental 
injuries, poisoning, their antidotes, etc. 

Dr. Kistler has spent much time and gone to a considerable outlay of money in the 
preparation of this useful work. 

It is hardly necessary to say that Dr. Kistler is eminently fitted both by education and 
by reason of his long and successful practice of the healing art, to write a book of this 
nature, as he is so well and favorably known in this city and throughout our and the 
neighboring counties. 

He was, however, greatly assisted by a trained nurse, who is also a practicing 
physician of good standing and a lady of high culture, to whom he acknowledges her 
valuable assistance. 

As a general text book it is a useful publication alike to the busy practitioner, teacher, 
student and family. The book contains twenty-six chapters, comprising about 350 pages, 
and forms a text book almost indispensable to families, especially those who are so- 
situated that a physician cannot be easily summoned. It treats elaboratelj- on home 
nursing and remedies, sick cookery, ventilation and disinfection, and is replete with 
valuable recipes and suggestions, both in health and sickness. 

The Critic predicts a large sale for the book, which it certainly merits. 

— Allentown Critic. 

1 iii 



Dr. W. P. Kistler. of this city, has completed his book on medicine, entitled "Practical 
Medical and Surgical Family Guide in Emergencies." It is a very comprehensive and 
well written volume full of sound and valuable information, giving plain directions how 
to act in cases of emergencies before the arrival of skilled professional help, aud full ot 
hints on how to take care of your health, etc. Everything is written in a plain and 
concise manner, so that the veriest layman can understand it. The book is dedicated to 
Rev. Dr. A. R. Home by the author. 

— Allentown Chronicle and News. 

Catasauqua, Pa., Aug. 23, 1894. 
Dr. W. P. Kistler : 

Dear Sir: I believe your book entitled " Practical Medical and Surgical Family 

Guide in Emergencies " will prove interesting and valuable to people in all walks of life. 

First, because of the important topics therein treated, and second, because you have 

treated these topics in a style that is clear and interesting. I hope the work may have a 

wide circulation. 

Yours respectfully, 

T. W. Bevan, 

Department of Public Schools. 

Allentown, Pa., Sept. 10, 1894. 
Dr. W. P. Kistler : 

Dear Sir: I take pleasure in recommending your book, "Practical Medical and Sur- 
gical Family G*uide in Emergencies," to the general public, and especially to heads of 
families, who will find it invaluable in the household. 

Having assisted in pieparing a part of the work for the press, and so knowing the 
aim of the volume, I am fully convinced that it contains information not only most 
essential in every family, but of great use also to the unmarried. 

If the advice you give under the various heads is strictly followed, I am confident 
much suffering will be averted aud often a life saved. 

Wm. J. Grim, 

Formerly Editor Critic. 

Eehighton, Pa., July 26, 1894. 
I take pleasure in saying that W. P. Kistler, M. D., was for a number of years the 
physician in my father's family while he still practiced at Schnecksville, Pa. During 
those years I had abundant opportunity to convince myself of his medical qualifications. 
He has had a varied and extensive practice and has always ranked foremost among the 
medical fraternit}-. I do not hesitate to say that he is eminently fitted to write such a 
book as he has just issued — " Medical and Surgical Family Guide for Emergencies." The 
book will undoubtedly- find a large aud extensive sale and do a great deal of good. It 
shall have a prominent place in my family. 

John A. Kuder, 
Pastor, Trinity Evangelical Lutheran Church. 

Kutztown, Pa., Aug. 24, 1894. 
To whom it may concern: Dr. W. P. Kistler, of Allentown, was for a number of years 
our family physician and I am intimately acquainted with him. I regard him as a first- 
class doctor and his efforts were attended with wonderful success. Lately he issued a 
" Medical and Surgical Family Guide in Emergencies,"— a book which should be found in 
every home. If properly followed the Guide will prove a great blessing to humanity and 
I predict a large sale for it. 

Very truly, 

David S. Keck, 
Prof, of English Grammar and Literature, Keystone State Normal School. 

Allentown, Pa., July 12,1895. 
To whom it may concern: I have examined with some care Dr. W. P. Kistler's 
44 Medical and Surgical Family Guide," and have no hesitation in saying that it answers 
every purpose that the author intended it should. I consider it invaluable in many 
instances when circumstances are such that medical aid can not be summoned promptly. 
As a work containing valuable information on subjects discussed, I am of the opinion 
it has few superiors. 

F. D. Raub, 
Superintendent Public Schools of 'Allentown, Pa. 

Allentown, Pa., August 31, 1894. 

To all whom it may concern: Some time ago I was kindly favored with a prospectus 
from W. P. Kistler, M. D., of this city, of his estimable work entitled. " Medical and 
Surgical Family Guide in Emergencies." I gave it more than a passing notice. After 
had the work thoroughly reviewed, I was more than pleased with it. It will till a Ion 
felt want. 



The book is just what it claims to be aud will accomplish that for which it is intended. 
Its own merits will best recommend it to all who make themselves acquainted with its 
contents and use it accordingly. 

It should not only recompense the Author for the labor he bestowed upon it but every 
one for the privilege of using it as it is intended. 

Yours truly, 

J. S. Renninger, 
Pastor of St. Joseph's Evangelical Lutheran Church of Allentown , Pa. 

South Bethlehem, Pa., July 16, 1894. 
Da. W. P. Kistler : 

Dear Sir: After carefully examining and thoroughly digesting the prospectus of 
your thorough and useful work, " Medical and Surgical Family Guide in Emergencies," 
I take pleasure in endorsing it. 

Without a doubt it is a most comprehensive and desirable work which will not only 
aid the laity, but will also be of great value to physicians and students of medicine as a 
work of ready reference. I unquestionably recommend it as invaluable in every house- 
hold. I am, 

Very faithfully yours, 

C. Edward Stout, M. D., 

427 West 4th Street. 

Senate of Pennsylvania, July 9, 1894. 
Dr. W. P. Kistler : 

Dear Sir : I have had the pleasure of examining the prospectus of your medical 
work entitled " Practical Medical and Surgical Family Guide." 

In my opinion the book fills a long felt want. The State of Pennsylvania by an Act 
of Assembly approved April 2, A. D. 1885, considered the subject of physiology and 
hygiene of sufficient importance to enact a law making it compulsory to be taught in the 
common schools of the Commonwealth. The people can not be too well educated in that 
particular. Your work gives common sense and practical ideas with reference to rules 
of hygiene and in my opinion the work should be in every household. If the recom- 
mendations and suggestions therein contained are carefully studied and carried out, 
much suffering ignorantly contracted and endured can be prevented It will be partic- 
ularly valuable to teachers and instructors who under the foregoing law are to teach 
physiology and hygiene in the public schools. 

Yours truly, 

Milton C. Henninger, 

Senator 16th District, Pa. 

Allentown, July 7, 1894. 
During the past year it was my privilege to read most of the manuscript for the work 
entitled " Practical Medical and Surgical Family Guide in Emergencies." While exam- 
ining the table of contents and the manuscript, I could not do otherwise than reach the 
conclusion that a great deal of time and labor were spent in the preparation of said work ; 
and not in vain, for I am convinced that teachers and students of physiology will find 
this book very helpful. In my opinion it is a volume that should find its way into every 
household. I bespeak for it a"rapid sale since it is worth many times the price. 

E- S. Dieter, 
Prof. Academic Department, Muhlenberg College. 

Allentown, Pa., July 7, 1894. 
I have carefully examined the prospectus of Dr. Kistler's "Medical and Surgical 
Family Guide," and find it a work that is sure to fill a long felt want. It is a book that 
ought to be in the hands of every one who is able to read the English language. 

Its language is clear and definite, discardiug such foreign terms that can ouly be 
understood by one versed in the Science of Medicine. 

In order to appreciate the value of the work it must be read. As a hand-book of 
medicine, it certainly has no equal and merits a very extensive sale. I am yours etc., 

Alvin Rupp, 
Superintendent Public Schools, Lehigh County. 

Allentown, Pa., July 7, 1894. 
I have known Dr. W. P. Kistler for many 3'ears and I believe his medical knowledge 
to be full and exact. An examination of his new " Medical and Surgical Family Guide in 
Emergencies," shows him to possess a peculiar talent for writing a work of this kind. 
The information is comprehensive and the language clear and simple. Arranged for 
ready reference, it enables one to know instantly what is best to do in an emergency. 
The book will prove an excellent family manual and deserves an extensive circulation. 

L,. B. L,andis, 

Ex-Superintendent of City Schools. 



Allentown, Pa., July 7, 1894. 

Among the most trying experiences of the average person in cases of serious accidents 
and emergencies, is the period of time between the happening of the accident until such 
a time as the doctor arrives, 

To know what to do in these emergencies has often been the means of saving the life 
of the injured, or at least, of making the sufferer more comfortable and alleviating his 
severe pain. 

Much valuable information on " What to do until the Doctor comes, " and on many 
other subjects, may be obtained from the excellent work entitled — "Practical Medical 
and Surgical Family Guide in Emergencies," by Dr. W. P. Kistler, a practicing physician 
of Allentown, Pa. 

The book is written in plain English and in such a style as to be intelligent to the 
average reader. 

Judging from the prospectus, the table of contents and the very large number of the 
most practical subjects treated, I predict a very large demand for the work. 

It is a useful book for any person and for every family. 

J. O. Knatjss, 

Ejv-Sufit. Public Schools, Lehigh County. 

L,ITZENBERG, PA., JULY 6, 1 894. 

Dr. W. P. Kistler : 

Dear Sir: I have carefully examined the prospectus of the work published under 
your name entitled "Medical and .Surgical Family Guide in Emergencies," and am 
pleased to say that I was very favorably impressed by the thorough and explicit manner 
with which you present the many different diseases and their thorough treatment. The 
book certainly merits a large sale, and should be in the possession of every family able 
to read the English language. 

A. P. Fetherolf, M. D. 

House of Representatives, Harrisburg, Pa. 
It is with pleasure that I recommend to the public in general the very valuable work 
of Dr. W. P. Kistler, entitled " Medical and Surgical Family Guide, " on account of its 
real merit. The book is replete with information of a nature indispensable to every 
family. The work contains twenty-six chapters, each of which alone is worth the price 
of the book. In the case of accident or other emergency, its value must be measured by 
the estimate we place on life, health and comfort. I have had the pleasure of reading a 
large part of the manuscript, and feel safe in saying that a subscription for this work 
is money well invested. 

Milton N. Bernhard. 

Allentown, Pa., July 6, 1894. 
I have examined the advance sheets of Dr. W. P. Kistler's forthcoming work 
"Practical Medical and Surgical Family Guide in Emergencies," and have found the 
same very satisfactory. The work will fill a long felt want. It is written from a common 
sense standpoint by a physician of long time experience, who knows exactly what is 
necessary for the bulk of the people. That this book will be worth many times its price 
in the hands of every one, I have not the least doubt. It should be in the hands of 
teachers, parents, and men and women everywhere, and I most cheerfully so recom- 
mend it. 

A. R. Horne, 

Editor of National Educator. 

Allentown, Pa., July 9, 1894. 
Dr. W. P. Kistler : 

Dear Sir: Having read a portion of the manuscript used in the make-up of j^our 
" Family Guide " and knowing your ability in the line of the healing art as shown in the 
treatment of myself and family, I am not at all surprised at the meritorious features of 
your production, and bespeak for the same a sale beyond your most sanguine expectations. 
It is a work that I believe should be in the hands of every family, especially in those 
where parents take an interest in the physical improvement of their children. 

Respectfully yours, 

A. J. Zellner, 0/ Zf>//«(T 5;w. 

Second National Bank, Allentown, Pa., July 9, 1S04. 
Dr. W. P. Kistler, M. D., 

Dear Sir : I have examined with more than ordinary interest the prospectus and 
advance sheets of your new work, " Practical Medical and Surgical Guide," intended for 
the instruction and guidance of the family in emergencies. 

It gives me pleasure to express my admiration for the intelligent and comprehensive 
manner in which the work has been done. 

As a " Family Doctor Book " it will fill a place in the home library, the want of which 
at times, would be worth many times its price. 

Very respectfully yours, 

WM, H. Ainev. PrrsiJcnt. 

vi 



Dr. Eugene M. Kistler, 

Physician and Surgeon, 

Office and Residence: 
313 NORTH SEVENTH ST., ALLENTOWN, PA. 

DISEASES OF THE 

Eye, Ear, Nose and Throat a Specialty. 

Also Refraction of the Eyes for the adjustment 
of Glasses. 

PATIENTS SUPPLIED WITH SPECTACLES AND EYE CLASSES. 

Recommendations: — A graduate (after three full courses 
of lectures) of Bellevue Hospital Medical College, New York. 
Eighteen months' service (the last six months as House Surgeon) 
at St. Vincent's Hospital, New York. Six months service at The 
Manhattan Eye and Ear Infirmary, New York, and six months 
as Resident Physician at The Hackensack General Hospital, in 
Hackensack, N. J. 



What a Man Knows . . . 

is what makes him useful in a community. The better he 
knows it, the better for his neighbors. 

The only way a man can acquire exact and complete 
knowledge of a subject is to make a specialty of it. A 
Jack of all trades knows just enough of each trade to spoil 
the job. 

Teeth are precious things to trust to a dental Jack 
of all trades. They are safer with a specialist. The 
specialist is more economical. Dr. WATT is the only 
Dental specialist in the Lehigh Valley. 

Sole owner and discoverer of the painless method for extracting 
teeth without sleep or danger. 

Dr. J. BOND WATT, 

6TH AND WALNUT STS., ALLENTOWN, PA. 



Dr. JAEGER'S 

Normal Sanatory Underclothing, 

Guaranteed to be of absoluely pure Animal 
Wool. 

No such good were ever before offered to the American 
public. They excel in every textile quality; in fineness of wool; 
in softness and delicacy of texture in various weights, from the 
lightest summer quality to the heaviest winter wear. In the 
manufacture of this underwear, the natural gray, or white wool is 
used, and being undyed and of the finest quality ; makes a garment 
so soft and pliable as to be not only non-irritating, but positively 
pleasurable to the most delicate skin. The garments made double 
over the chest and abdomen, afford special protection, at all times 
to the vital organs, and thus conduce to the general health. 
There is abundant reason to believe that all those who adapt the 
Dr Jaeger Woolen Underwear, will be nearly, if not entirely 
protected against attacks of Pneumonia, Phthisis and lung 
affections in general. 

FOR SALE ONLY BY 

Koch & Shankweiler, 

LEADING CLOTHIERS AND OUTFITTERS, 

ALLENTOWN, PA. 



Allentown Business College, 

-AND INSTITUTE OF 

Shorthand, Type-writing and 

Telegraphy, 

804 HAMILTON STREET, - - ALLENTOWN, PA. 

It is the First and Foremost Institution of its kind in the Lehigh 
Valley. 

W. L. BLACKMAN, 

-Established in 1869. Principal. 



PETERS 8t S]V[ITH, 

Druggists and Chemists, 
639 HAMILTON ST., ALLENTOWN, PA. 

WHOLESALE jEr AND RETAIL. 




The most complete stock of Drugs, Chemicals, 
Patent Medicines and Druggists' Sundries in the 
Lehigh Valley. 

SURGICAL INSTRUMENTS. 

We carry a large line of Surgical Instruments and 
Appliances, Syringes, Hot Water Bottles, Rubber 
Goods, Trusses and Supporters. 

We make a specialty of compounding Physicians' 
and private prescriptions with the greatest of care and 
having a large trade, moving goods rapidly we have no- 
accumulation of old and deteriorated stock. 

Mail and telephone orders will receive prompt 
attention. 

Respectfully, 

PETERS & SMITH. 










Cea/j-rf (So'ty/f/^.y^u^/pU^/^. 



A COMMERCIAL HICH 
SCHOOL 

The largest, most thorough, best 
regulated and finest equip- 
ped school in the state 
outside of Phila- 
delphia. 
Six Complete Departments. 

Nine Competent I nstructors. 



DAY AND EVENING SESSIONS. 

Business from the start. No theory. Graham and B. Pitman Short- 
hand, and all the leading typewriting machines on the market. Catalogue 
free. 

O. C. nORNEJT, Prirutipal. 






^bLErtT6W/1,P/V. 



